ACL Surgery and Scarring: What You Need to Know

A close-up of two knees showing surgical scars, with a person sitting on a bed.

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Anterior cruciate ligament (ACL) surgery helps restore knee stability after injury. Many patients have questions about scarring following surgery and how these marks might change over time. This article explains what to expect regarding scarring after ACL surgery, how to manage scars, and scar treatment options.

Understanding ACL Surgery Scars

ACL reconstruction usually leaves several small scars instead of one big cut. During the surgery, the doctor makes small openings to insert a camera and surgical tools.

Arthroscopic incisions: Most ACL surgeries involve 2 to 4 tiny cuts around the knee, each about 0.5 to 1 cm long. These small openings, often called “keyhole” cuts, let the surgeon work inside the knee with minimal damage to the surrounding tissue.

Graft harvest scars: If your surgeon uses a tendon from your own body (autograft), you may have an additional scar where this tissue was taken.

If the tendon is taken from the inner thigh (hamstring area), it usually leaves a 3 to 5 cm scar on the inner side of the knee.
If it’s taken from just below the kneecap, it typically leaves a short, straight scar at the front of the knee.

Scar appearance timeline: Right after surgery, scars are usually red or purple and may be slightly raised. Over the next 6 to 12 months, they usually become flat and fade into pale, thin lines that are less visible.

Factors Affecting Scar Appearance

Skin type and genetics: Your natural healing tendency affects scar formation. Some people develop more prominent scars due to genetic factors.

Surgical technique: Minimally invasive approaches typically result in smaller scars compared to traditional open surgery techniques.

Post-operative care: How you care for your incisions after surgery impacts final scar appearance.

Age and general health: Younger patients often heal with less noticeable scarring, while conditions like diabetes might slow healing and potentially affect scar appearance.

Managing Scars After an ACL Surgery

Follow wound care instructions: Keep incisions clean and dry according to your surgeon’s guidance. Avoid soaking in baths or swimming pools until incisions have completely closed.

Sun protection: New scars are sensitive to sun exposure. Cover healing scars when outdoors or apply sunscreen (SPF 30+) once wounds have closed completely to prevent darkening.

Avoid strain on healing tissue: Follow activity restrictions during recovery to prevent wound separation, which could lead to wider scars.

When to Seek Medical Advice

While some scarring is normal, certain signs warrant medical attention.

Excessive redness or warmth: If your scar remains very red, warm, or increasingly painful several weeks after surgery, consult your doctor to rule out infection.

Unusual texture or growth: Scars that become raised, thick, or grow beyond the original wound edges (known as keloid or hypertrophic scars) may benefit from early intervention.

Functional limitations: Seek advice if scar tissue seems to restrict your movements.

Scar Treatment Options

If you’re concerned about the appearance of scars after they’ve matured (6-12 months post-surgery), several options exist.

Silicone treatments: Silicone sheets or gels applied to healed scars have shown improvements in scar appearance. These products help hydrate the scar tissue and regulate collagen production.

Topical treatments: Various creams and ointments containing ingredients like vitamin E, onion extract, or hyaluronic acid may help improve scar appearance, though evidence varies regarding their effectiveness.

Professional treatments: For more noticeable scars, dermatological procedures like laser therapy, microneedling, or steroid injections might be considered. These should only be pursued after your surgical site has completely healed.

Conclusion

Scarring after ACL surgery is normal and typically minimal with current surgical techniques. Most scars fade significantly within the first year after surgery. With proper wound care and patience, many patients find their surgical scars become less noticeable over time.

If you have concerns about how your scars are healing after ACL surgery, consider speaking with your surgeon or a knee specialist for advice on scar care and recovery.

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.