An ACL tear is one of the most common serious knee injuries, particularly in athletes and active individuals. When the anterior cruciate ligament tears, the knee loses stability. Daily activities become difficult, and returning to sport without treatment carries a high risk of further damage to the knee cartilage and meniscus.
ACL surgery in Chennai at Bharath Orthopaedics is performed by Dr. Bharath Loganathan, an orthopaedic surgeon with over 20 years of experience and more than 13,000 joint procedures to his name. This page explains what ACL surgery involves, who needs it, what recovery looks like, and how to make an informed decision about your treatment.
What Is the ACL and Why Does It Tear?
The anterior cruciate ligament is one of four major ligaments in the knee. It runs diagonally through the centre of the joint and controls rotational stability, preventing the tibia (shin bone) from sliding forward on the femur (thigh bone) during pivoting and cutting movements.
ACL tears typically occur during non-contact events. A sudden change of direction, landing awkwardly from a jump, or stopping sharply at speed are the most common mechanisms. They are particularly common in football, basketball, badminton, and kabaddi. Direct contact injuries, such as a tackle to the side of the knee, can also cause ACL tears.
The injury often produces a pop at the moment it occurs, followed by rapid swelling within a few hours, and a feeling that the knee is unstable or about to give way.
Symptoms of an ACL Injury
The following signs suggest an ACL tear and warrant prompt orthopaedic assessment:
- A loud pop or snapping sensation at the moment of injury
- Rapid swelling of the knee within 2 to 6 hours of injury
- Instability or a feeling that the knee is giving way, particularly during pivoting movements
- Pain and difficulty bearing weight on the affected leg
- Stiffness and reduced range of motion in the days following injury
- Difficulty continuing physical activity at the time of injury
Not all ACL injuries are complete tears. Partial tears occur and may present with milder symptoms. A clinical examination is essential for diagnosing an ACL injury. MRI is commonly used to confirm the diagnosis and assess associated injuries to the meniscus, cartilage, or other ligaments.
Does Every ACL Tear Need Surgery?
Not always. This is one of the most important questions to address because the answer varies significantly between patients.
Surgical reconstruction is generally recommended for patients who want to return to sport involving pivoting or cutting movements. It is also recommended for those with functional instability during everyday activities, younger active patients where conservative management is unlikely to restore adequate stability, and patients with associated meniscal or cartilage injuries.
Non-surgical management with physiotherapy and bracing may be appropriate for older or less active patients whose functional demands do not require rotational stability. It is also suitable for partial tears where the remaining ligament provides adequate function. A detailed clinical assessment, including imaging and functional evaluation, will determine which approach is appropriate.
At Bharath Orthopaedics, every patient undergoes a thorough evaluation before any recommendation is made. Surgery is not the default recommendation. It is the recommendation when the clinical evidence supports it.
Before Surgery: Pre-Operative Rehabilitation (“Prehab”)
Where surgery is planned, pre-operative physiotherapy can meaningfully improve outcomes. The goals of prehab are to restore full knee extension, reduce joint swelling, and activate the quadriceps before the operation. Patients who go into surgery with a calm, well-moving knee generally regain range of motion and quad strength faster afterward.
Surgical Options: Repair vs. Reconstruction
Most ACL tears are treated with reconstruction — replacing the torn ligament with a graft. However, for certain proximal (avulsion-type) tears with good remaining tissue quality, primary ACL repair may be an option. This involves preserving and re-fixing the patient’s native ligament, sometimes with an internal brace for added stability, rather than replacing it entirely. Suitability for repair versus reconstruction depends on the tear pattern, tissue quality, and timing since injury, and is assessed on a case-by-case basis.
Types of ACL Surgery: Graft Options
ACL reconstruction involves replacing the torn ligament with a graft tissue that integrates with the bone over time and functions as a new ligament. The two main graft sources are:
Autograft (patient’s own tissue): The most commonly used option. The graft is taken from one of three sites:
- The patellar tendon (bone-tendon-bone), providing strong bone-to-bone healing, though it is associated with a higher chance of anterior knee pain and discomfort when kneeling.
- The hamstring tendons (gracilis and semitendinosus), offering good strength with less donor-site pain, though some patients experience persistent hamstring weakness or a degree of graft stretch over time.
- The quadriceps tendon, increasingly popular due to its large graft volume and generally lower donor-site morbidity than the patellar tendon; often used in specific cases or revision surgery.
Allograft (donor tissue): Allograft tissue may be considered in selected patients, including some older or less active individuals and certain complex or revision cases. The choice depends on factors such as age, activity level, previous surgery, and the surgeon’s assessment.
The choice of graft depends on the patient’s age, activity level, specific anatomy, and whether it is a primary or revision reconstruction. This is discussed at consultation after reviewing the imaging.
How ACL Reconstruction Is Performed
ACL reconstruction is performed arthroscopically, meaning through small keyhole incisions. There is no need for a large open incision.
- Anaesthesia: Spinal or general anaesthesia is administered depending on the patient’s preference and medical profile.
- Arthroscopic assessment: A small camera is inserted into the knee to confirm the diagnosis, assess the full extent of injury including the meniscus and cartilage, and plan the reconstruction precisely.
- Graft preparation: The chosen graft is harvested and prepared to the correct length and diameter.
- Tunnel creation: Small tunnels are drilled into the femur and tibia at precisely the anatomic footprint of the original ACL. Accuracy in tunnel placement is critical for restoring natural knee mechanics.
- Graft fixation: The graft is passed through the tunnels and secured at each end using fixation devices. The graft is tensioned under direct vision to restore stability.
- Wound closure: Incisions are closed and a compression dressing applied.
The procedure typically takes 60 to 90 minutes. Most patients go home the same day or the following morning.
Recovery After ACL Surgery
ACL recovery is measured in months, not weeks. This is the most important expectation to set correctly from the start. The graft undergoes a gradual biological process called ligamentisation, during which it remodels and adapts to function as a ligament. This process continues for many months after surgery, while strength, neuromuscular control, and functional recovery are progressively restored.
The recovery follows structured phases:
Days 1 to 3: Ankle pumps and gentle active foot/ankle movement are started early to promote circulation and reduce the risk of calf blood clots (DVT), alongside pain and swelling control.
Weeks 1 to 2: Focus on reducing swelling, restoring basic range of motion, and beginning gentle quad activation exercises. Walking with crutches initially.
Weeks 2 to 6: Progressive weight bearing, improving flexion and extension, beginning strengthening of the quadriceps and hamstrings. Many patients gradually progress away from crutches during this period, although the timeline varies depending on the reconstruction, associated injuries, and rehabilitation progress. Note: if a meniscal repair or cartilage procedure was performed alongside the ACL reconstruction, weight-bearing is often restricted or protected in a locked brace for 4 to 6 weeks, which changes this timeline.
Weeks 6 to 12: More structured strengthening, proprioception training, and introduction of light cycling and swimming. Return to straight-line jogging typically begins around week 10 to 12 when quad strength has recovered sufficiently.
Months 3 to 6: Sport-specific training begins. Running, lateral movements, and change-of-direction drills are introduced progressively.
Months 6 to 9: Return to full training in most cases, subject to passing objective strength and functional tests.
9 to 12 months: Return to competitive sport for most patients. Returning to pivoting or competitive sport too early may increase the risk of reinjury. Most athletes require 9 to 12 months or longer, with return based on objective strength, functional, movement-quality, and psychological readiness criteria rather than time alone. Common benchmarks used before clearance include a Limb Symmetry Index above 90% on quad and hamstring strength testing, a satisfactory psychological readiness score (such as ACL-RSI), and successfully completing a multi-stage hop test battery.
Adhering consistently to a structured rehabilitation programme is one of the most important factors influencing recovery and return to activity after ACL reconstruction.
For a detailed week-by-week guide to ACL recovery, read our article on ACL surgery recovery timeline.
Post-Operative Care at Home
Pain management: Paracetamol is the preferred first-line pain relief. NSAIDs such as ibuprofen may be prescribed for pain and inflammation in some patients. In the first 2 to 4 weeks after surgery, NSAIDs are typically used more cautiously, as they can interfere with early bone-to-tendon healing within the drilled tunnels. Use them only as directed by your surgeon, particularly if you have other medical conditions or are taking other medicines.
Ice and elevation: Apply ice wrapped in a cloth for 15 to 20 minutes several times a day during the first two weeks. Keep the leg elevated above heart level when resting to reduce swelling.
Wound care: Keep the surgical site clean and dry. Avoid submerging the knee in water until the wounds are fully healed, typically 10 to 14 days after surgery.
Crutches and bracing: Most patients use crutches for 1 to 2 weeks. A knee brace may be prescribed for the first 4 to 6 weeks depending on the extent of the repair. Follow your surgeon’s specific guidance on weight bearing.
Blood clot (DVT) prevention: Starting gentle ankle pump exercises soon after surgery, staying as mobile as your surgeon allows, and wearing compression stockings if advised all help reduce the risk of deep vein thrombosis in the early recovery period.
Warning signs: Contact your surgical team promptly if you develop increasing redness, warmth, or discharge from the wound, fever above 38 degrees Celsius, significant calf swelling or pain suggesting DVT, or a sudden giving way of the knee that was not present before.
Who Is Dr. Bharath Loganathan?
Dr. Bharath Loganathan is a senior orthopaedic surgeon at Bharath Orthopaedics in Chennai with over 20 years of experience in joint and ligament surgery. He holds an MS in Orthopaedics, MRCS from the Royal College of Surgeons of Edinburgh, and DNB in Orthopaedics. He completed advanced fellowship training at the Ranawat Orthopaedics Centre in the United States.
He has performed over 13,000 joint procedures and has extensive experience in arthroscopic knee surgery including ACL reconstruction, meniscal repair, and complex multi-ligament injuries.
Bharath Orthopaedics is recognised by Outlook as the Best Robotic Joint Replacement Centre in Chennai. The clinic’s structured patient care pathway covers pre-operative assessment, surgical treatment, and post-operative rehabilitation planning under one team.
- Years of Experience: Over 20+ years
- Qualifications: MBBS, MS (Orthopaedics), DNB (Orthopaedics)
- Available Time: Mon-Sat 9 am to 8 pm | Sun – 10 am to 3 pm
- Address: Flat-A Ground Floor , Balaji Villa, New Door No.38/1, Old Door No.9/1, Rajaratnam Street, Kilpauk, Chennai-600010.
When to See a Specialist
If you have had a knee injury involving a pop, rapid swelling, and instability, seek orthopaedic assessment within the first few days. Early assessment allows MRI imaging to be requested promptly, associated injuries to be identified, and a treatment plan to be formed before muscle wasting sets in.
If you are managing a known ACL injury conservatively but finding your knee gives way during normal activities, reassessment is warranted to determine whether surgical reconstruction would provide better long-term outcomes.
For appointments at Bharath Orthopaedics in Chennai, visit our contact page. You can also read more about knee procedures at Bharath Orthopaedics and physiotherapy for knee pain as part of your recovery plan.
Read also Recovery from Hip Replacement.