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Key Takeaways
- ACL reconstruction replaces a torn anterior cruciate ligament with a tendon graft to restore knee stability and function.
- Not every ACL tear requires surgery. Treatment depends on your symptoms, activity level, knee stability, and personal goals.
- Recovery takes time. A structured rehabilitation programme is essential for regaining strength, mobility, and safely returning to sports or daily activities.
A torn anterior cruciate ligament (ACL) is one of the most common knee injuries, especially among people who play sports that involve sudden stopping, pivoting, or jumping. An ACL tear can make your knee feel unstable, making it difficult to return to sports or even some everyday activities.
ACL reconstruction surgery replaces the torn ligament with a new tendon (called a graft) to restore knee stability. The goal is to help you regain movement, reduce episodes of the knee giving way, and return to the activities you enjoy after proper rehabilitation.
What is ACL reconstruction surgery?
ACL reconstruction is a minimally invasive arthroscopic procedure used to replace a torn anterior cruciate ligament. Instead of stitching the damaged ACL back together, your surgeon removes the torn ligament and replaces it with a tendon graft that gradually becomes your new ligament.
The graft may come from:
- Your own body (autograft), such as the hamstring, patellar tendon, or quadriceps tendon
- A donated tendon from a tissue bank (allograft)
The procedure usually takes around one to two hours and is commonly performed as day surgery or with a short hospital stay.
When should I consider ACL reconstruction surgery?
Not everyone with a torn ACL needs surgery. Many people regain solid knee function through rehabilitation and by adjusting the daily activities that put stress to their joint.
Your doctor may recommend reconstruction if you have:
- Recurring instability: Your knee keeps giving way, even during everyday movement
- Sports involving pivoting or jumping: You want to return to activities that put rotational stress on the knee
- Instability despite physiotherapy: Your knee still feels unreliable after a proper course of rehab
- Combined injuries: The ACL tear comes with meniscus or cartilage damage
- High physical demands: Your work or sport requires dependable knee stability
- Everyday difficulty: Instability is getting in the way of ordinary daily tasks
If your activity level is lower, or the tear is only partial, non-surgical treatment is often tried first.
Can an ACL tear be treated without surgery?
Not every ACL tear needs surgery. Some people do well without it, particularly if the tear is partial, their knee still feels stable, and their daily activities don't involve much twisting or pivoting.
Non-surgical treatment usually involves:
- Structured physiotherapy to build up the muscles around the knee so they take on more of the stabilising work
- Activity modification, which means backing off the movements that stress the knee most
- A knee brace for certain activities, if your doctor thinks it will help
- Pain relief medication when you need it
- A staged return to normal activity, guided by your care team rather than by how the knee feels on a good day
This approach doesn't suit everyone. If your knee keeps buckling, if you want to get back to sports that involve cutting and pivoting, or if you've also torn a meniscus, your orthopaedic surgeon is more likely to recommend ACL reconstruction.
Your age, how active you are, what symptoms you're getting, and what you actually want to get back to all feed into that decision, and it's worth talking through each of them at your appointment.
Who is ACL reconstruction most suitable for?
ACL reconstruction is generally most suitable if you have a significant ACL tear and want to restore knee stability for an active lifestyle. It is often recommended for people who experience repeated episodes of their knee giving way and wish to return to sports or work that involve cutting, pivoting, sudden changes of direction or jumping.hss+1
Your surgeon may consider ACL reconstruction particularly appropriate if you:
- Are physically active and want to continue sports such as football, basketball, netball, skiing or similar high‑impact activities.
- Have persistent knee instability despite a structured physiotherapy programme.
- Notice your knee buckling during everyday tasks, such as walking on uneven ground, going up or down stairs, or turning quickly.
- Have combined injuries inside the knee, for example meniscus tears or cartilage damage, which may worsen if the knee remains unstable.
- Are younger or middle‑aged and wish to protect your knee from further damage over time.
On the other hand, if you have a partial ACL tear, lower activity levels or medical conditions that make surgery higher risk, non‑surgical treatment with physiotherapy and activity modification may be considered first. Your surgeon will discuss which option best matches your goals, knee condition and overall health.
Speak with our care team today to be matched with an orthopaedic specialist who can assess your knee, explain your options, and help you plan the next steps in your treatment.
An ACL tear is a serious knee injury that often causes sudden pain, a popping sensation, rapid swelling, and a feeling that the knee is unstable or may give way.
What happens if an ACL tear is left untreated?
An untreated ACL tear doesn't always cause ongoing problems. For some people, though, the knee stays unstable, and that instability is what leads to further damage inside the joint over time.
What can happen:
- The knee gives way repeatedly, usually during a sudden twist or change of direction
- Meniscus tears, which become more likely the longer the knee stays unstable
- Wear on the joint cartilage, which raises the risk of longer-term joint problems
- Less ability to play sport or do physically demanding work
- Trouble with ordinary movements like stairs or uneven ground
- A higher chance of developing knee osteoarthritis later on, particularly where repeated giving-way has damaged the joint further
Not everyone with an ACL tear will experience the complications listed above. Your orthopaedic surgeon can help determine whether non-surgical treatment or ACL reconstruction is the most suitable option for your condition.
What should I consider before getting ACL surgery?
Choosing ACL reconstruction is a personal decision that depends on your lifestyle, goals, and overall knee condition.
Before deciding, consider:
- Your age and how active you are
- Whether competitive sport is something you want to return to
- How unstable the knee actually feels day to day
- Other injuries inside your knee
- Your general health and whether surgery is safe for you
- How much time you can commit to rehabilitation, because the outcome depends heavily on it
Recovery takes several months of consistent physiotherapy. The surgery reconstructs the ligament, but it won't restore knee function on its own.
How should I prepare for ACL reconstruction surgery?
Preparing well before surgery can improve your recovery and lowers the chance of complications.
Preoperative preparation
Your surgeon will go through your medical history, current medications, allergies, and any previous surgery. You may be asked to:
- Stop certain medications, such as blood thinners
- Stop smoking, if that applies to you
- Arrange for someone to take you home afterwards
- Avoid food and drink for several hours beforehand
Physical examination
Your doctor will examine your knee to assess:
- Range of motion
- Knee stability
- Swelling
- Strength in the surrounding muscles
Imaging tests such as MRI scans and X-rays may also be reviewed to confirm the injury and pick up any associated damage.
Graft discussion
One of the important decisions before surgery is which graft to use.
Your surgeon will talk through the pros and cons of each option, taking into account your:
- Age
- Activity level
- Sporting goals
- Occupation
- Previous knee surgeries
The most suitable graft varies from person to person.
Physiotherapy
Many people benefit from physical therapy before ACL surgery, often called prehabilitation.
Your physiotherapist may work with you to:
- Reduce knee swelling
- Get movement back in your knee
- Strengthen the quadriceps and hamstrings
- Improve balance
Going into surgery with a knee that already moves and holds strength well generally makes the recovery smoother.
Anaesthesia
ACL reconstruction is usually done under:
- General anaesthesia, where you're asleep for the procedure
- Regional anaesthesia, such as a spinal anaesthesia, sometimes with sedation
Your anaesthetist will discuss which is more suitable for you.
How is ACL reconstruction surgery performed?
ACL reconstruction is usually performed using arthroscopy through small incisions around the knee.
Knee examination
Your surgeon inserts a small camera, called an arthroscope, into the knee joint.
Before anything else happens, they examine the torn ACL and check whether your meniscus, cartilage, or other ligaments have been damaged too.
Damaged ACL removal
The torn ACL fibres are removed to make room for the graft.
Your surgeon then drills small tunnels through your femur (thigh bone) and tibia (shin bone), which is what allows the graft to sit in the right position.
Grafting
Your prepared tendon graft is threaded through the bone tunnels and held in place with fixation devices such as screws or buttons.
Over time, the graft integrates with the surrounding bone and starts doing the job your original ACL used to do.
Closing
Once your surgeon is satisfied with the graft position and the stability of your knee:
- Surgical instruments are removed
- Small incisions are closed with stitches or surgical tape
- A dressing and compression bandage are applied
Most patients are able to return home on the same day.
ACL reconstruction is a procedure that restores knee stability by replacing a damaged ACL with a new ligament made from a tendon graft.
What are the risks and complications of ACL reconstruction surgery?
ACL reconstruction has a high success rate, but like any surgery, complications can occur.
These include:
- Infection
- Bleeding
- Blood clots
- Knee stiffness
- Persistent pain or swelling
- Graft failure or re-tear
- Loosening of fixation devices
- Numbness around the incision
- Limited knee movement
- Continued knee instability
Your surgeon will go through these with you beforehand and explain how each one is managed if it does happen.
Immediate postoperative care
Your care team will keep an eye on you while the anaesthesia wears off.
Before you're discharged, you'll be given instructions covering:
- Your pain medication
- Looking after the wound
- Icing the knee to bring swelling down
- Using crutches, if you need them
- Wearing a knee brace, if one has been prescribed
- Gentle exercises to start early on
- When to come back for follow-up
Keeping your leg elevated in those first few days, and sticking to what your doctor has told you, makes a real difference to how much you swell.
ACL reconstruction recovery timeline
Your recovery won't look identical to anyone else's, but rehabilitation is the part that determines how well you end up.
Note: Recovery timelines vary depending on your injury, surgery, and commitment to rehabilitation. Always follow your surgeon's and physiotherapist's advice before you move up to the next stage.
When should you seek medical attention after surgery?
You should expect some pain, swelling, and stiffness after ACL reconstruction, and it should ease as the knee heals. Some symptoms, though, point to a complication and need looking at quickly.
Contact your doctor if you experience:
- Fever or chills
- Increasing redness, warmth, or pus around the surgical wound
- Severe or worsening pain that is not relieved by medication
- Excessive swelling that suddenly worsens
- Persistent drainage from the incision
- Calf pain, swelling, or tenderness, which may be a sign of a blood clot
- Chest pain or difficulty breathing, which requires immediate emergency medical attention
- New numbness or weakness in your leg or foot
- A sudden feeling that your knee has become unstable or given way after surgery
Going to your follow-up appointments and following your rehabilitation programme can help your healthcare team monitor your recovery and identify any concerns early.
Costs of ACL reconstruction surgery
What you pay depends on where you have the surgery, your surgeon's fees, the type of graft, the implants used, and whether any additional procedures are required at the same time.
Public hospitals
Public hospitals cost less because of government subsidies. If you're eligible for subsidies, ACL reconstruction generally falls somewhere between SGD 4,000 and SGD 6,000, though this shifts with your ward class, how long you stay, and whether additional procedures are needed.
Private clinics
Private hospitals and specialist centres usually offer:
- Shorter waiting times
- Greater flexibility in choosing your surgeon
- Faster access to surgery
You'll pay more than you would in the public system.
Available payment options
Depending on your eligibility and where you're treated, you may be able to use:
- MediSave
- Integrated Shield Plans
- Private health insurance
- Employer medical benefits
- Instalment payment plans offered by some hospitals
Your healthcare provider can advise which financing options apply to your situation.
How HiA helps with ACL reconstruction
If you are experiencing ongoing knee pain, instability, or difficulty returning to sports after an ACL injury, Health in Asia (HiA) helps you connect with experienced orthopaedic surgeons who specialise in knee and ligament (ACL) reconstruction.
Whether you need an initial assessment, a second opinion on surgery, or further investigations such as MRI scans, HiA makes it easier to find and book appointments with appropriate knee specialists.
Speak with our Care Team today to be matched with an orthopaedic specialist who understands your condition and can guide you through the next steps in your treatment.
Frequently asked questions
Yes. Although it is performed using minimally invasive arthroscopic techniques, ACL reconstruction is considered a major orthopaedic surgery because it involves replacing a damaged ligament and requires several months of rehabilitation.
ACL surgery itself is not painful because your knee is numbed or you are under general anaesthesia, so you won’t feel anything during the operation. After surgery, it is normal to have soreness, swelling and stiffness for the first few days, but pain is usually manageable with medicines, ice and rest, and it improves steadily over the next weeks.
A completely torn ACL does not usually grow back to normal on its own, which is why surgery or structured rehab is often recommended to restore knee stability. However, some partial or selected complete tears can heal or become functionally stable with the right bracing and physiotherapy, so your doctor will advise whether surgery or non-surgical rehab makes most sense in your case.
Usually, no. If it’s urgent, act on the first doctor’s advice right away. If it’s not urgent, taking a little time to check can save you from going the wrong way.
That’s a good outcome. It means you can move ahead with more confidence and stop second-guessing the plan.
Yes. Send us what you have. If anything's missing, we'll tell you exactly what to request and how.
Disclaimer
This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition. For decisions about your health or treatment, speak with a qualified doctor who knows your situation. An…
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