ACL Surgery: What It Is and How It Works

Injuries to the anterior cruciate ligament (ACL) are one of the most common knee injuries, with approximately 100,000 to 200,000 reported annually in the U.S.¹ ACL injuries often occur when the ligament is sprained, torn or ruptured as a result of sports or other trauma.

Continue reading to learn more about ACL surgery and how it works, including the price you can expect to pay for the procedure.

What Is ACL Surgery?

Based on the severity of your injury, your doctor may recommend surgery to repair your ACL. This involves replacing the torn ACL with a tendon to connect the muscle to the bone and stabilize the knee, which in time will hopefully return to full mobility.²

There are three types of tendon grafts used for ACL surgery:²

• Autograft uses your own tendon taken from your other knee, hamstring or thigh.
• Allograft uses a tendon from someone else, such as a donor or cadaver.
• Synthetic graft uses man-made materials such as carbon fiber or Teflon to replace the tendon.

How it works

For ACL surgery, patients usually go under general anesthesia shortly before the procedure, although other methods of anesthesia may also be used, such as regional anesthesia or a block.³

Surgeons typically use arthroscopic surgical techniques when performing ACL surgery, meaning a tiny camera is inserted into the knee through a small incision. Arthroscopic methods tend to result in less scarring of the knee tissue than other methods.³

The surgeon removes the damaged tendon and repairs any surrounding tissue. They then replace the ACL with the new tendon (autograft, allograft or synthetic) by drilling small tunnels in the bone to bring the new tendon through and securing it in place with screws. New bone grows and fills in the tunnels, holding the new ligament in place as it heals.³

ACL Surgery Cost

The national average price for ACL surgery in the U.S. is $15,445, though costs range from $9,504 to $26,137.⁴

Costs for ACL surgery in the U.S. vary widely based on a number of factors, including the severity of the injury, the type of surgery recommended by your doctor, whether you have the surgery in a hospital or outpatient center, what kind of rehab is needed, what type of health insurance you may have and your geographic location.

Most health insurance plans will cover ACL surgery once your doctor has determined the procedure is medically necessary. Out-of-pocket costs for insured patients will vary based on your deductible, copays and whether you have the surgery in-network at an inpatient facility, such as a hospital, which is typically more expensive than having the procedure at an outpatient surgical center.⁵

Other costs to consider include:⁵

• Evaluation appointments with your doctor or medical team
• Diagnostic and lab tests
• Fees for the surgeon, anesthesiologist, graft procedure and operating room
• Postsurgical care including medications and aids such as a brace, crutches or compression wrap
• Physical rehabilitation therapy
• Follow-up appointments with your doctor

Consider your surgeon's experience and expertise, as well as positive patient outcomes when factoring in the variable costs for the entire procedure and recovery process.

ACL Injury Grades

The ACL is one of two important ligaments (strong bands of tissue) that stabilize the knee and connect the thigh bone to the shinbone. ACL injuries are categorized as sprains and are assessed by severity.⁶

• Grade 1: The ligament has been stretched but is able to perform its function of stabilizing the knee.
• Grade 2: Often referred to as a partial tear, the ligament has stretched to the point of becoming loose.
• Grade 3: Commonly called a complete tear, the ligament has been torn in half or pulled completely from the bone. The knee is unstable.

Almost half of all ACL injuries also include damage to other areas of the knee, such as the meniscus, cartilage or other ligaments.⁶ Partial tears of the ACL ligament are uncommon; most ACL injuries are complete or nearly complete tears.⁶

Common Reasons for ACL Injuries

The anterior cruciate ligament is commonly injured as a result of sports or other high-impact trauma such as:²

• Changing direction quickly
• Stopping suddenly
• Direct impact to the knee area
• Pivoting on a planted foot
• Landing incorrectly after a jump

ACL Injury Symptoms

You may hear a popping noise or feel your knee give out from under you if you've damaged your ACL. Other symptoms include:⁷

• Severe pain and rapid swelling
• Loss of range of motion
• Inability to bear weight on the injured leg
• A feeling of instability while walking
• Tenderness around the knee joint

If you think you've experienced an ACL injury, it's crucial you're seen by a doctor as soon as possible to diagnose the severity of the injury and receive proper treatment. You risk causing further damage to the complex structure of ligaments, cartilage and joints that make up the knee if you attempt to resume normal activity without an assessment.⁷

Who Is a Good Candidate for ACL Surgery?

Activity level, rather than age, is used as a general guideline when medical professionals assess whether or not ACL surgery is appropriate for their patients. Adults who are generally healthy and active in sports, or have a job that requires manual labor, pivoting and hard turning, should consider ACL surgery.⁸

Likewise, ACL repair surgery for children or adolescents with ACL tears may help lower their risk of future meniscus or cartilage injuries. Patients with ACL tears that compromise their functional stability run a higher risk of damaging other areas of the knee, causing further complications.⁸

ACL Surgery Risks

All surgeries carry some postsurgical risk, including infection, bleeding at the wound site, shock, blood clots, trouble urinating, breathing issues or adverse reactions to anesthesia.²

ACL surgery in particular carries risks such as:⁸

• Numbness. It's not uncommon to have numbness or paralysis of the leg or foot post-surgery, or numbness of the outer upper leg near the surgical site.
• Instability. Chronic instability occurs in 5% to 10% of patients due to a stretching of the reconstructed tendon.
• Stiffness. Some patients report knee stiffness or loss of mobility due to an excess of scar tissue, which may need to be surgically removed or the knee manipulated while under anesthesia.
• Knee pain. Postoperative anterior knee pain, pain behind the kneecap or pain while kneeling are common after ACL surgery.

ACL Surgery Recovery

Many patients are able to go home on the same day of surgery.³ Your care team will instruct you on how to properly dress and care for the wound, which may include keeping your knee elevated, icing the wound site and wearing a compression bandage to manage swelling.² Depending on the type of surgery and the extent of reconstruction, it's likely you'll wear a knee brace and potentially use crutches for the first one to six weeks post-surgery.³

Pain management

Pain after surgery is part of the healing process and you may be prescribed short-term medication for pain relief.⁸ Your doctor may prescribe over-the-counter medications like acetaminophen, ibuprofen or naproxen.² They may also prescribe prescription pain medication like meloxicam or gabapentin.²

Physical therapy

Successful rehabilitation after ACL surgery largely relies on the patient's willingness to engage in the prescribed physical therapy, beginning immediately postsurgery.⁸

Physical therapy in the first seven to 10 days after surgery aims to straighten the leg and regain the use of the quadriceps muscles. Other goals of physical therapy include reducing swelling, maintaining kneecap mobility to minimize stiffness, restoring a full range of motion to the knee and rebuilding strength in the quadriceps and hamstrings.⁸

Many patients are cleared to return to sports or regular activities within six to 12 months, depending on their rehabilitation progress.⁸

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Author Bio

Anne-Marie Kennedy is a freelance writer with more than 20 years of experience covering health and wellness, personal finance and real estate/investing.