This post was written by Dr. Robert Klitzman, sports medicine surgeon, Parkview Orthopedics.
As an orthopedic surgeon who treats knee injuries every day, one of the most common, and most feared, diagnoses I see is an ACL tear. Whether you’re a young athlete, a parent of a competitive player or an active adult who simply enjoys staying fit, an ACL injury can feel overwhelming. My goal with this article is to answer the most common questions I hear in my office and help reduce some of the uncertainty around ACL tears and reconstruction.
Are ACL tears always traumatic?
In almost all cases, yes. ACL tears are traumatic injuries. Unlike some shoulder or overuse injuries, people don’t usually “walk in” with an ACL tear and no idea how it happened. Patients almost always recall a specific moment — a bad landing, a sudden pivot, a collision or a fall — when they felt or heard something go wrong in their knee.
This traumatic tearing is why ACL injuries are so common in sports like basketball, soccer and football, where cutting, pivoting and rapid changes in direction place tremendous stress on the knee.
ACL repair vs. ACL reconstruction
You’ll often hear people talk about “ACL repair,” but medically speaking, we generally don’t repair the ACL, we reconstruct it.
That distinction matters. A torn ACL is usually not sewn back together. Instead, we create a new ACL using a graft, which becomes the patient’s new ligament over time. Understanding this difference helps patients better grasp why recovery and rehabilitation take months rather than weeks.
Can you prevent an ACL tear?
This is one of the most important and complicated questions I get, especially from parents of young athletes.
You can’t change the ACL itself, but research suggests that neuromuscular training programs can reduce the risk of ACL injuries, particularly in high-risk groups like girls’ soccer and basketball players. Programs such as the well-researched PEP Program focus on:
- Strengthening key muscle groups
- Improving hip and knee control
- Teaching proper landing and cutting mechanics
These programs work best when built into a team’s warm-up routine. When injury-prevention exercises become part of what athletes already do, compliance is much higher than when they’re treated as “extra work.”
While no program can guarantee prevention, there are simply too many uncontrollable factors, incorporating this type of training can help reduce risk.
The most common questions patients ask before ACL surgery
When someone comes to see me after an ACL tear, their questions are usually very practical:
- When can I get back to my sport?
- When can I return to work?
- How long will recovery and rehab take?
For younger patients, parents often want to know how much school their child will miss. These are all fair questions, and the answers depend on several factors, including age, activity level, job demands and the type of sport or work someone plans to return to.
In general:
- Desk jobs allow for an earlier return than physically demanding jobs
- Straight-line activities (like running) come back sooner than cutting sports
- Sports like soccer and basketball place much higher demands on the ACL than non-pivoting activities
Graft choices: How a new ACL is made
During ACL reconstruction, we use a graft to create the new ligament. We do not use synthetic materials. Instead, we rely on biologic tissue that the body can incorporate and remodel.
The most common graft options include:
- Patellar tendon autograft (your own tissue)
- Hamstring tendon autograft (your own tissue)
- Donor (allograft) tissue
Each option has advantages and trade-offs, and graft choice is not one-size-fits-all.
How I decide which graft to use
For young athletes, I typically use patellar tendon or hamstring tendon grafts. These grafts have lower re-tear rates early on and are better suited for athletes returning to high-demand sports.
For active adults or “weekend warriors”, especially those who need to return to work quickly and don’t rely on their ACL for their job, a donor graft can be a good option. Donor grafts:
- Tend to be less painful initially
- Often allow for an easier early recovery
- Require more protection during the first year because they are weaker while the body incorporates the tissue
Because donor grafts have a higher re-tear rate in the first year if stressed too early, I reserve them for patients who are able to follow restrictions carefully.
What happens during ACL reconstruction surgery?
Regardless of graft choice, the overall process is similar:
- Tunnels are drilled in the tibia and femur where the ACL naturally belongs
- The graft is passed through these tunnels
- The graft is fixed in place using screws or other fixation devices
The main difference lies in how the graft is secured, depending on whether it includes bone (patellar tendon) or is soft tissue (hamstring or donor graft).
What has the biggest impact on recovery outcomes?
Once surgery is over, physical therapy becomes the most important factor in recovery.
Not all physical therapy is the same. Therapists specialize just like surgeons do. A physical therapist who regularly works with athletes recovering from ACL surgery will provide a very different experience than one who primarily treats neurological conditions or low-demand patients.
Choosing an experienced orthopedic surgeon and a physical therapist who specializes in knee rehabilitation can make a meaningful difference in outcomes.
Not all ACL injuries are the same
Many patients say, “I tore my ACL,” but the reality is often more complex. ACL tears frequently occur alongside:
- Meniscus tears
- Injuries to other knee ligaments (like the MCL)
- Cartilage damage
A patient with an isolated ACL tear will have a very different recovery than someone with multiple associated injuries. Even though the diagnosis sounds the same, the surgery, rehabilitation and long-term outlook can vary significantly.
Early motion and modern recovery
Early movement after ACL surgery is critical to prevent stiffness and restore normal knee motion. While devices like continuous passive motion (CPM) machines were once widely used, modern recovery relies more on guided exercises, physical therapy protocols and patient education.
The key is following a structured rehabilitation plan and progressing at the right pace, not rushing, even when the knee starts to feel good.
Key takeaways
ACL tears are challenging injuries, but with the right surgical approach, graft selection and rehabilitation, most patients can return to the activities they love. Education, patience and consistency are just as important as the surgery itself.
If there’s one takeaway I emphasize to my patients, it’s this: who you choose for your care — both surgeon and physical therapist — truly matters.
At Parkview, we offer a full range of services to help you get moving again — because when it comes to reclaiming your life, there’s no better time than today. You can find Parkview Orthopedics near you at parkview.com/ortho or schedule in Carmel directly at 317-804-1020.
