Sports Injury & Ligament Reconstruction
ACL Reconstruction Surgery by Dr. Tanveer Bhutani
An ACL tear is one of the most common sports injuries affecting athletes and active individuals. A torn ACL causes instability, repeated giving way of the knee, and increases the risk of meniscus and cartilage damage. At Eva Hospital, Dr. Tanveer Bhutani performs advanced arthroscopic ACL reconstruction using evidence-based techniques tailored to each patient’s anatomy, sporting demands and associated injuries.
Understanding the injury
What is the ACL?
The anterior cruciate ligament (ACL) is one of the four main ligaments that stabilise the knee joint. It runs diagonally through the middle of the knee, connecting the thigh bone (femur) to the shin bone (tibia).
- Provides rotational stability during pivoting and cutting movements
- Prevents excessive forward movement of the tibia relative to the femur (anterior tibial translation)
- Works together with the menisci and surrounding muscles to keep the knee stable under load
When the ACL tears, the knee loses this rotational control, which is why patients often describe the knee “giving way” during sport rather than during simple walking.
Mechanism of injury
How Does an ACL Tear Occur?
Hip replacement components may be fixed to the bone using bone cement or may be designed for biological bone ingrowth.
Sports Injuries
Football, cricket, basketball, badminton and kabaddi are common causes, especially with sudden direction change or jumping.
Twisting Injuries
A sudden pivot or change of direction with the foot planted on the ground can rupture the ligament.
Landing After a Jump
Awkward landing with the knee straight or twisted is a frequent cause in basketball and volleyball players.
Road Traffic Accidents
Direct impact to the knee, particularly in two-wheeler accidents, can injure the ACL along with other structures.
Contact Injuries
A direct blow to the side of the knee during contact sport can force the joint out of alignment.
Recognising the injury
Symptoms of an ACL Tear
An Audible Pop
Many patients report hearing or feeling a distinct pop at the moment of injury.
Immediate Swelling
Swelling typically develops within hours due to bleeding inside the joint.
Instability
A feeling that the knee cannot be trusted to bear weight confidently.
Knee Giving Way
Episodes of the knee buckling, especially while turning or changing direction.
Difficulty Pivoting
Trouble with rotational movements such as changing direction while running.
Reduced Confidence
Hesitation or fear of re-injury during sport or uneven ground.
Reaching an accurate diagnosis
How is an ACL Tear Diagnosed?
History
Clinical Examination
Lachman Test
Anterior Drawer Test
Pivot Shift Test
MRI
Standing X-rays
Why MRI alone doesn’t decide treatment
An MRI confirms the tear and helps identify associated meniscus or cartilage injury, but it does not by itself determine whether surgery is needed. That decision is based on the patient’s age, activity level, degree of instability on clinical examination, and personal goals, considered together with the imaging findings.
An important distinction
Partial vs Complete ACL Tear
| Partial Tear | Complete Tear |
|---|---|
| A portion of the ligament fibres remain intact | The ligament is fully ruptured with no continuity between fragments |
| May provide some residual rotational stability | Rotational stability is lost, increasing the risk of the knee giving way |
| Selected cases may be managed without surgery, with close monitoring | Reconstruction is usually recommended for young, active patients in pivoting sports |
| Often associated with lower-energy twisting injuries | More frequently associated with meniscus and cartilage injury |
Associated injuries
A significant proportion of ACL tears occur alongside meniscus tears or cartilage damage, which is why a thorough MRI review and examination are essential before planning treatment.
The most important question
Do All ACL Tears Require Surgery?
Conservative (Non-Surgical) Treatment
Non-operative management, built around physiotherapy and activity modification, can be a reasonable option for:
- Elderly patients
- Sedentary individuals with low functional demands
- Medically unfit patients where surgical risk is a concern
- Selected partial tears with a stable clinical examination
Complete ACL Tears in Active Patients
For young, active patients participating in pivoting sports, reconstruction is usually recommended, because persistent instability increases the risk of secondary meniscal and cartilage damage over time. That said, the decision should always be individualised after a full clinical assessment — not applied as a blanket rule.
The cost of waiting
Why Delaying Surgery Can Be Harmful
Repeated Instability
Meniscus Tear
Cartilage Damage
Early Arthritis
Each episode of the knee giving way places additional stress on the meniscus and articular cartilage. Over time, repeated instability is one of the main drivers of early degenerative change in the knee.
Choosing the right graft
ACL Graft Options
No single graft is “always best.” The right choice depends on age, sport, occupation, anatomy and associated injuries.
| Graft | Advantages | Considerations |
|---|---|---|
| Hamstring Tendon | Smaller incision, less anterior knee pain, strong graft | Some studies report slightly higher rotational laxity in certain patients |
| Bone-Patellar Tendon-Bone (BTB) | Bone-to-bone healing, popular in pivoting-sport athletes | Higher risk of anterior knee pain and kneeling discomfort |
| Quadriceps Tendon | Larger graft diameter, good option for revision surgery | Technique-sensitive harvest, can cause quadriceps-site discomfort |
| Allograft (Donor Tissue) | No donor-site morbidity, shorter surgical time | Generally reserved for older, lower-demand patients due to a higher re-tear risk in young athletes |
What Dr. Tanveer Bhutani commonly recommends
Graft selection is individualised, taking into account the patient’s age, sport, occupation, tunnel anatomy, and any associated ligament or meniscus injury. There is no universal “best” graft — the right choice is the one matched to the person, not the procedure.
Often overlooked, always important
ACL Fixation Methods
Femoral fixation options include suspensory fixation (using a button or loop on the outer bone surface) and aperture fixation (using a screw closer to the joint surface).
Tibial fixation options include interference screws, suspensory fixation, and hybrid techniques combining more than one method.
Graft augmentation
Internal Bracing / Graft Augmentation
A useful adjunct in selected situations — not a routine necessity for every ACL reconstruction.
- A strong suture tape placed alongside the graft to share load during early healing
- May protect the graft while it biologically incorporates in the first few months
- Often considered in revision ACL surgery
- Sometimes used in high-demand athletes returning to pivoting sport
Internal bracing is best understood as graft augmentation and protection during early healing — a tool for specific situations rather than a routine add-on for every patient. Whether it is appropriate depends on the graft used, the stability found during surgery, and the patient’s activity goals.
Preserving the meniscus
Meniscus Injuries with ACL Tears
An estimated 50–70% of ACL injuries have an associated meniscus tear. The meniscus acts as a shock absorber for the knee, so preserving it matters for long-term joint health.
- Repair is performed whenever the tear pattern and blood supply allow it
- Meniscectomy (trimming) is reserved for tears that cannot be repaired
- Meniscus treatment is planned alongside ACL reconstruction, not as an afterthought
What to expect in the operating room
Surgical Technique, Explained Simply
Arthroscopic Assessment
Small camera portals allow the surgeon to inspect the torn ligament, meniscus and cartilage.
Graft Harvest
The chosen graft tissue is carefully harvested through a small incision.
Graft Preparation
The graft is sized and prepared on the back table while the joint is further assessed.
Tunnel Creation
Precise femoral and tibial tunnels are drilled to match the graft's natural position.
Graft Fixation
The graft is passed and fixed using the method best suited to the patient.
Associated Repairs
Any meniscus or cartilage injury identified is treated in the same sitting.
The road back
Rehabilitation Timeline
Recovery follows a structured, physiotherapy-led programme rather than a fixed calendar.
| Recovery Timeline | Rehabilitation Goals |
|---|---|
| Week 1 | Pain and swelling control, gentle range-of-motion exercises, weight-bearing as advised. |
| Week 2 | Progressive range of motion, quadriceps activation, walking with support as needed. |
| Week 6 | Improved strength and balance, stationary cycling, gait normalisation. |
| 3 Months | Progressive strengthening, introduction of controlled jogging where appropriate. |
| 6 Months | Sport-specific drills, agility and change-of-direction training begin under supervision. |
| 9 Months | Functional and strength testing guide readiness; many athletes are not yet cleared to return before this point. |
| 12 Months | Full sport-specific testing and confidence-based return-to-play assessment. |
Calendar vs readiness
Return to sport should be based on functional recovery and objective testing rather than the calendar alone, although in practice many athletes do not return before about nine months.
Getting back to what you love
Return to Sports and Daily Activities
Driving
4–6 weeks*
Swimming
6–8 weeks*
Cycling
8–12 weeks*
Gym / Squats
3–4 months*
Running
4–5 months*
Cricket
6–8 months*
Football
9+ months*
*Indicative timelines only — actual clearance depends on individual strength and functional testing, not the calendar.
Risks and Honest Expectations
Like any surgery, ACL reconstruction carries risks. Most patients recover well, but outcomes depend on patient factors, surgical planning, and rehabilitation.
- Infection
- Re-tear of the graft
- Stiffness
- Cyclops lesion
- Deep vein thrombosis (DVT)
- Persistent instability
Excellence in care
Why Choose Dr. Tanveer Bhutani?
Careful Examination
Diagnosis based on thorough clinical assessment, not imaging alone.
Individualised Graft Selection
Graft and fixation chosen for the patient, not a fixed protocol.
Associated Injury Treatment
Meniscus and cartilage injuries treated in the same sitting where possible.
Associated Injury Treatment
Meniscus and cartilage injuries treated in the same sitting where possible.
Explore further
Related Pages
Frequently Asked Questions
Selected partial tears in low-demand patients may be managed without surgery, but most complete tears in active individuals do best with reconstruction due to ongoing instability risk.
There is no single ‘best’ graft. Hamstring, BTB, quadriceps tendon and allograft each have advantages and trade-offs; the right choice depends on your age, sport and anatomy.
Strength depends on the combination of graft, fixation device, bone quality and tunnel position — not on any one fixation type in isolation. Your surgeon selects the method suited to your case.
Internal bracing is a useful adjunct in selected situations, such as revision surgery or high-demand athletes, rather than a universal upgrade needed by every patient.
Instability and associated meniscus or cartilage damage are known risk factors for early arthritis. Timely, appropriately planned treatment helps reduce — though not eliminate — this risk.
Many athletes return to football, typically after around nine months or more, once functional and strength testing confirm readiness.
Yes, squatting is reintroduced progressively during rehabilitation as strength and control improve, usually from around 3–4 months.
Controlled jogging is often introduced around 3–4 months, progressing to full running once strength and confidence criteria are met.
Most patients can resume driving once they have good knee control and are off strong pain medication, often around 4–6 weeks — always confirm with your surgeon.
This depends on how physically demanding your job is. Desk-based work may resume within 1–2 weeks; physically demanding jobs take longer.
ACL reconstruction typically takes 1–1.5 hours, though this varies if meniscus repair or other associated procedures are needed.
Many patients are discharged within 24–48 hours, depending on pain control, associated procedures, and general fitness.
Meniscus tears are treated in the same surgery whenever possible — repaired if the tear pattern allows, or trimmed if repair isn’t feasible.
Not always immediately — swelling and range of motion are often optimised with physiotherapy first (‘prehab’) before scheduling surgery.
A partial tear means some ligament fibres remain intact, which may allow some residual stability; treatment still depends on clinical assessment.
Through a combination of patient history, clinical tests (Lachman, anterior drawer, pivot shift), and MRI to confirm the tear and check for associated injuries.
Yes — structured physiotherapy before and after surgery is essential to regain strength, motion and confidence in the knee.
It is a nodule of scar tissue that can form in front of the ACL graft, sometimes limiting full knee extension and occasionally requiring a minor procedure to remove.
Yes, re-tear is a recognised risk, particularly if return to sport happens before adequate strength and control are regained.
It’s reasonable to be assessed within a few weeks of injury so that a treatment plan — surgical or non-surgical — can be individualised early.
Is Knee Instability Limiting Your Life?
Book a consultation with Dr. Tanveer Bhutani at Eva Hospital, Ludhiana, and get a clear, honest plan for your ACL injury.