ACL Repair vs Reconstruction: What’s the Difference

An older man is sitting indoors, holding his knee with a pained expression.

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The anterior cruciate ligament (ACL) is one of the key ligaments that stabilises your knee joint, helping you pivot, twist and move with confidence. When this ligament is torn, often during sports or sudden directional changes, it can lead to knee instability and long-term joint issues if left untreated.

This article explores the two main surgical approaches for ACL injuries: ACL repair and ACL reconstruction. Learn how these procedures differ, what each involves and which option may be more suitable depending on the type and severity of your tear.

What is ACL Repair?

ACL repair is a surgical procedure that aims to fix the torn ligament without replacing it. Instead of removing the damaged ligament, the surgeon works to reattach and strengthen your existing ACL tissue.

Stitches are used to hold the ligament together, and small anchors may be placed to help secure it in position.

What is ACL Reconstruction?

ACL reconstruction is a surgical procedure where the torn ligament is removed and replaced with a new one. This new ligament, called a graft, is usually made from tissue taken from another part of your own body or it may come from a donor.

During the procedure, small tunnels are made in the thigh bone and shin bone to position the new graft where the original ACL was located. This helps restore strength and stability to your knee as it heals.

Key Differences Between ACL Repair and Reconstruction

While both procedures aim to restore knee stability after an ACL injury, there are important differences in how they are performed and who they are suitable for.

Use of natural tissue: ACL repair keeps your own ligament intact by reattaching the torn ends, whereas reconstruction replaces the damaged ligament with new tissue.

Surgical method: Repairs are typically done using smaller incisions and may take less time in the operating room for an ACL repair compared to reconstruction.

Recovery process: Recovery times can vary from person to person, but both procedures require a structured rehabilitation programme to regain strength and movement.

Who Might Be Suitable for ACL Repair?

Not all patients with ACL injuries are candidates for repair surgery.

Individuals with a tear near the end of the ligament where it connects to the bone
Patients whose ligament tissue is healthy enough to be stitched back together
Those who seek medical treatment soon after the injury occurs
Younger individuals who may have better healing potential

Who Might Need ACL Reconstruction?

Reconstruction is a common procedure, particularly for:

Patients with a tear located in the middle part of the ligament
Individuals whose ligament tissue is too damaged or weak to be repaired
Those with long-standing ACL injuries where the tissue has worn down over time
Active people who need strong knee stability for sports or physical activities

Choosing the Right Treatment

The decision between ACL repair and reconstruction should be made in consultation with an experienced knee surgeon. Factors such as age, activity level and the specific pattern of the ACL tear all play a role in determining the most suitable approach. It is important to discuss how each option may affect long-term knee function and recovery.

Conclusion

ACL repair and reconstruction are both effective surgical options for treating ACL injuries, with each approach suited to specific tear patterns and individual needs. Understanding the differences between these procedures can help you prepare for recovery and make informed choices about your knee health.

If you are experiencing knee instability or suspect an ACL injury, consider consulting a knee specialist for a timely diagnosis and a personalised treatment plan.

Dr. Ambrose Yung

Specialist Orthopaedic Hip & Knee Surgeon

Dr Ambrose Yung Wai Yin is a Senior Orthopaedic Hip & Knee Surgeon with over 20 years of experience in the field of orthopaedics.

Areas of Expertise:

Knee Surgery: Complex procedures like revision knee arthroplasty, partial knee replacement, and primary total knee replacement.
Minimally Invasive Surgery: Shoulder, ankle, and knee surgeries with minimal scarring and quicker recovery times.
Limb Reconstruction: Specialized in both upper and lower limb reconstruction.

Computer-guided Knee Replacement: Dr. Yung trained at the prestigious Oxford University Hospital in the UK, where he specialized in computer-guided partial and total knee replacements.

Dr. Chee Kin Ghee

Specialist Hand & Orthopaedic Surgeon

Dr Chee Kin Ghee is a specialist hand surgeon with over 20 years of experience in hand and orthopaedic surgery.

His clinical expertise includes treatments for complex hand, wrist, and upper limbs injuries, wrist and finger joint replacement, minimally invasive hand and wrist surgery, and nerve compression release surgery

Dr Chee was awarded a 1-year fellowship (HMDP by MOH) & trained at world-renowned Wrightington Hospital Upper Limb Unit, UK.
He was trained in the management of complex upper limb conditions, including complex joint replacement of the shoulder, elbow, wrist, and hand, as well as modern minimally invasive upper limb surgery.

Dr. Low Mun Hon

Dr Low Mun Hon has over 20 years of experience managing trauma and orthopaedic clinical care. Prior to this, he has been in private practise as a practitioner at Singapore Sports & Orthopaedic Clinic (SSOC).

Dr. Low graduated from Monash University Medical School (Melbourne). Thereafter, he pursued his internship at The Alfred Hospital in Melbourne.

He subsequently continued his practice of medicine at Singapore General Hospital (SGH). During this period, he was awarded the membership of the Royal College of Physicians and Surgeons at Glasgow in 2008 & Master of Medicine in Orthopaedic Surgery (National University of Singapore) in the same year.
Dr Low had previously worked as an orthopaedic trainee at various local teaching hospitals i.e. Ng Teng Fong General Hospital (NTFGH), Tan Tock Seng Hospital (TTSH), KK Women’s and Children’s Hospital (KK Hospital) and Singapore General Hospital (SGH).

Justin Lim Xuan Li

Physiotherapist

Justin is a skilled and experienced physiotherapist who specializes in the treatment of neuro-musculoskeletal conditions (nerve, muscle and joint).

Over the years, he honed his clinical skills across all sectors of healthcare, allowing him to attain mastery of the sophisticated human body and address complex problems effectively, allowing him to successfully address complex neuro-musculoskeletal conditions at an accelerated pace.

Justin graduated from Trinity College Dublin and started his career in National Healthcare Group Polyclinics. His skills quickly gained recognition and was appointed as a clinical educator for physiotherapy students and even tasked to develop Clinical Practice Guidelines.
Subsequently, he continued his practice in community care settings such as Thye Hwa Kwan Rehabilitation Centres and Saint Andrew Community Hospital, where he focused on developing his skills for geriatric rehabilitation and improving quality of care in rehabilitation centres. He then moved on to private practice in Parkway East Hospital, specializing in post operative and outpatient rehabilitation.

Chan Jing Cheng (JC)

Physiotherapist

JC has over 12 years of experience in treating Chronic pain, Orthopaedic and Geriatric conditions.

He had worked at various Private Hospitals, Singapore General Hospital, NTUC Health Elder Care and Lions Home for the Elders.
He is passionate about solving complex musculoskeletal disorders and helping clients relief pain from trauma and illness.
He has a special interest in the Shoulder, Spine, Hip and Knee joint conditions.
He has helped thousands of clients go through rehabilitation smoothly and achieved higher satisfaction after orthopaedic surgery.

Zita Sham

Physiotherapist

Zita graduated with a Diploma in Physiotherapy from Nanyang Polytechnic (Singapore) in 2014 and started working in Ng Teng Fong General Hospital to serve her sponsorship bond.

Later in 2015, she pursued a Bachelor’s Degree in Physiotherapy from Trinity College Dublin, which was provided in Singapore Institute of Technology.

After completion of her studies, Zita worked in the Day Rehabilitation Centre in Jurong Community Hospital for 6 years, where she focused on community rehabilitation for a variety of patients. Patients that were mainly seen consisted of post-operative, geriatric and neurological conditions.
Zita also has a passion in musculoskeletal and sports physiotherapy and is looking to pursue that. She is also keen to provide home-based physiotherapy to reach out to those in need of her expertise.

Joanna Lim

Hand Occupational Therapy

Joanna’s primary specialization and passion is in hand therapy and upper limb rehabilitation, having more than 10 years of experience in this field.

Joanna obtained her Diploma in Occupational Therapy (Merit) from Nanyang Polytechnic in 2006. Under the MOH Health Science Scholarship, she graduated from La Trobe University, Australia, with a Bachelor’s degree in Occupational Therapy (1st class Honors) the following year. Upon graduation, she worked in Changi General Hospital and Sengkang General Hospital.

She has worked with hand and orthopedic surgeons in both inpatient and outpatient settings, providing quality therapy services for clients with a variety of hand and upper limb conditions, including fractures, sprains/strains, tendon injuries, nerve injuries, repetitive strain disorders and complex trauma injuries.
During her tenures at CGH and SKGH, Joanna was a Senior Occupational Therapist and held the role of Hand Therapy and Upper Limb Rehabilitation Unit Leader. She was in charge of clinical supervision and management of staff, manpower planning, and daily operations of the unit.