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ACL Repair vs ACL Reconstruction: What's the Difference?

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The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments in the knee, especially among athletes and active individuals. There are two main surgical approaches to treat a torn ACL: ACL repair and ACL reconstruction.

Although they may sound similar, they are very different in technique, goals, and indications. Here, we will break down the difference between ACL repair and reconstruction, and when each might be the more appropriate choice.

By Arete Orthopaedic Centre
Medically Reviewed by Dr Wang Lushun

What is the ACL?

The ACL is a strong band of tissue that connects the thigh bone (femur) to the shin bone (tibia). It helps stabilize the knee joint, particularly during activities that involve pivoting, cutting, or sudden stops. When the ACL is torn, the knee can feel unstable, especially during athletic movements, and there's a high risk of further injury if left untreated.

What Is ACL Repair?

ACL repair involves preserving and reattaching the torn ends of the patient’s original ligament. Instead of removing the damaged tissue, the surgeon sutures the torn ACL back to the bone or its attachment site.

When Is ACL Repair Used?

ACL repair is only appropriate in certain situations, such as:

The tear is near the ligament's attachment to the bone
The tissue quality is good, meaning the remaining ACL fibers are strong enough to heal
The patient is often younger and within a short time frame after the injury

Pros of ACL Repair:

Preserves the patient’s native tissue and nerve endings
Potential for faster recovery
Avoids graft harvesting

Cons:

Higher re-tear rates in some cases
Limited to specific types of tears
Long-term outcomes are still being studied

What Is ACL Reconstruction?

ACL reconstruction is more commonly performed. It involves removing the damaged ligament entirely and replacing it with a graft, which can be made from:

The patient’s own tissue (autograft), such as the hamstring, patellar tendon, or quadriceps tendon
Donor tissue (allograft)

The graft is secured inside the knee and acts as a scaffold for new ligament tissue to grow and integrate over time. This procedure is considered the gold standard for most ACL tears, especially in active individuals.

When Is ACL Reconstruction Used?

Reconstruction is appropriate in most cases of ACL rupture, particularly when:

The ligament is torn in the middle or has poor tissue quality
The patient is highly active, particularly in pivoting or contact sports
The injury is older, and healing potential is reduced

Pros of ACL Reconstruction:

More proven long-term outcomes
Lower risk of re-injury in most cases
Widely available and established technique

Cons:

Longer recovery time compared to some repair techniques
Involves graft harvesting, which can cause additional pain or weakness
Rehabilitation can be demanding and lengthy

To Repair or Reconstruct?

Deciding between ACL repair and reconstruction depends on several factors. Here are some things to consider:

Age and Activity Level: Younger, highly active individuals (especially athletes) tend to do better with reconstruction, as it has a lower failure rate over time. However, for select children or lower-demand patients, repair may be appropriate.
Tear Location and Severity: Only a small percentage of ACL tears qualify for repair, usually those at the femoral attachment site with good tissue quality. If the ligament is shredded or torn in the middle, reconstruction is the better choice.
Surgical Goals: Some patients prioritise faster recovery, while others want the most durable option with the least chance of reinjury. Your orthopaedic surgeon will discuss the pros and cons of each method tailored to your goals.

If you have suffered an ACL or knee injury, please contact us. We’ll go through your options and determine the best surgical approach for your specific injury and recovery goals.

Dr Wang Lushun

Senior Consultant Orthopaedic Surgeon

MBBS (S’pore), MRCS (Edin), MMed (Ortho), FRCS (Ortho) (Edin)

With over 18 years of experience, Dr Wang Lushun focuses on treating sports-related injuries, especially ACL injuries. His patients include former and current national athletes and sports professionals, as well as everyday individuals seeking orthopaedic care. Known for his patient-centric approach, Dr Wang offers tailored treatment programmes using advanced minimally invasive techniques to help patients restore an active, pain-free lifestyle.