What is ACL reconstruction?
ACL reconstruction is a keyhole operation that replaces a torn anterior cruciate ligament with a graft, a piece of tendon fixed inside the knee to act as a new ligament.
The ACL runs through the middle of the knee and connects the thigh bone to the shin bone. It keeps the shin from sliding forward and controls twisting. A torn ACL does not heal back on its own in most adults, so when the knee keeps giving way, the ligament is rebuilt rather than stitched.
The operation is done under spinal or general anaesthesia and normally takes 1 to 3 hours. The surgery is done through arthroscopy, or keyhole knee surgery. Small tunnels are drilled in the thigh bone and shin bone, the graft is passed through them in the position of the old ligament, and it is held with fixation devices such as screws that stay in the knee permanently. Over the following months, your body turns the graft into ligament-like tissue. During the same arthroscopy, the meniscus and cartilage are checked, because they are often injured along with the ACL, and a torn meniscus may be repaired or trimmed at the same time.
ACL tear symptoms to watch for
Common ACL tear symptoms are a pop at the time of injury, swelling within a day, pain, loss of full knee movement and a feeling that the knee gives way when you turn.
ACL injuries usually happen without a collision: landing awkwardly, stopping suddenly or twisting on a planted foot. This is common in cricket fielding, football, kabaddi raids and tackles, basketball, and even a slip on stairs or a wet floor.
- A popping noise or feeling at the moment of injury
- Quick swelling, usually within 24 hours
- Pain and difficulty putting full weight on the leg
- Not being able to fully straighten or bend the knee
- Later, the knee buckles or shifts when you turn, climb down stairs or change direction
The swelling may settle in a few weeks and the knee may feel almost normal while walking straight. That is why many young players ignore it, then get repeated giving-way episodes that can damage the meniscus and cartilage. If you have had a twisting injury with swelling, get a knee pain assessment early.
Who needs ACL surgery and who can manage with rehab
Who needs ACL surgery depends on activity and stability. Active people who play pivoting sports, do heavy manual work, keep getting giving-way episodes or have other knee damage usually benefit from reconstruction.
Not every ACL tear needs an operation. Non-surgical care, which means structured physiotherapy, a brace for sport and pain relief, can work well for people with partial tears and a stable knee, or for less active people who do not play twisting sports.
Surgery is usually advised when:
- You want to return to cricket, football, kabaddi, badminton, basketball or similar sports
- Your job is physically demanding, such as police, army, farm or construction work
- The knee gives way repeatedly in daily life despite physiotherapy
- The meniscus, cartilage or another ligament is also damaged
The AAOS suggests trying non-surgical care first in suitable patients and, if surgery is needed, doing it within about 5 months of injury to lower the risk of more meniscus and cartilage damage. Dr. Rai will discuss both paths with you and your family.
ACL graft options explained simply
ACL graft options are your own tendon (autograft), most often from the hamstring, the patellar tendon below the kneecap or the quadriceps tendon, or donor tissue (allograft) in selected cases.
- Hamstring tendon: taken from the back of the thigh through a small cut. It is a commonly used graft.
- Patellar tendon: the middle part of the tendon below the kneecap, taken with small bone pieces at each end. It can cause more kneeling pain at the front of the knee.
- Quadriceps tendon: taken from the tendon above the kneecap.
- Allograft: donor tendon, which avoids a second cut but is used less often in young athletes.
Each graft has pros and cons, and no single graft is right for everyone. The choice depends on your age, sport, kneeling needs at work or prayer, and any previous knee surgery. Dr. Rai will explain the option he recommends and why.
Risks of ACL reconstruction surgery
ACL reconstruction risks include infection, blood clots, knee stiffness, ongoing pain or instability, problems at the graft site, and tearing of the new graft, which may need further surgery.
Most people have no serious complications. Possible problems include:
- Wound or joint infection, which is uncommon
- Blood clots in the leg (deep vein thrombosis)
- Stiffness or loss of full movement, which early physiotherapy helps prevent
- Pain at the front of the knee or where the graft was taken
- Rarely, damage to a nearby nerve or blood vessel
- The graft stretching or tearing again, often from returning to sport too early
Shubhyash Hospital provides 24x7 trauma and emergency care if you have a fever, calf pain or a sudden change in the knee after surgery.
ACL rehab phases after surgery
ACL rehab runs in phases: control swelling and regain full straightening, rebuild strength and balance, then running and jumping drills, and finally sport-specific training before you are cleared to play.
Physiotherapy starts soon after surgery. Rehab is the single biggest factor in how well the knee works later, and it is a commitment of several months.
- Phase 1 (first 2 weeks): reduce swelling, get the knee fully straight, wake up the thigh muscle, walk with crutches.
- Phase 2 (about weeks 2 to 6): regain bending, walk without crutches, start cycling and light strengthening.
- Phase 3 (about months 2 to 4): heavier strength work, balance and single-leg control.
- Phase 4 (about months 4 to 6 onwards): straight-line running, then jumping, landing and change-of-direction drills.
- Phase 5: sport-specific training and return to play once strength and hop tests are close to the other leg.
These timings are a guide. Progress is based on milestones, not just the calendar.
Return to sport after ACL surgery
Return to sport after ACL surgery usually takes 6 to 12 months. The AAOS says most patients return within this window, and the NHS notes it can take up to a year.
Going back too early is a common cause of graft tears. Cricketers, footballers and kabaddi players face a lot of cutting, sudden stops and contact, so Dr. Rai looks at thigh strength, hop tests, balance and confidence before clearing you, not just the number of months. Gym-goers can usually return to supervised training earlier, but deep squats, heavy leg presses and jumping are built back in stages.
Students preparing for board exams, competitive exams or college trials should plan surgery and rehab around their calendar. Discuss your season, exam dates and travel with Dr. Rai at the first visit so the plan fits your life.
ACL surgeon in Varanasi: Dr. Shwetabh Rai
Dr. Shwetabh Rai is an ACL surgeon in Varanasi with MS (Ortho), DNB (Ortho), MCh and Diploma SICOT (Belgium), and over 12 years of orthopedic experience including sports injuries and arthroscopy.
He consults at Shubhyash Hospital & Speciality Clinic on Kautilya Kon Road, Bhojuveer, near Shivpur and Varanasi Cantt. The OPD runs till 10 PM, which helps students and working players who cannot come during the day. Patients come from Chandauli, Ghazipur, Jaunpur, Azamgarh, Mau, Ballia, Mirzapur and western Bihar.
Learn more about Dr. Shwetabh Rai, or call or WhatsApp +91 99567 61112 to book a sports injury consultation.
Your ACL surgery journey step by step
Injury assessment
Dr. Rai examines the knee for ligament looseness, meniscus signs and swelling, and asks about your sport, job and goals.
MRI and fitness tests
An MRI confirms the ACL tear and shows meniscus or cartilage damage. Routine blood tests and an anaesthesia check follow.
Pre-surgery physiotherapy
Exercises reduce swelling and restore movement so the knee is ready for surgery, which helps recovery afterwards.
Surgery day
Keyhole ACL reconstruction with the chosen graft, usually once early swelling has settled and the knee moves well. A torn meniscus may be treated at the same time. Most patients go home the same day or after one night.
Phase-wise rehab and follow-up
Follow-up visits and supervised physiotherapy over several months, with strength and hop testing before return to sport.
ACL reconstruction recovery timeline
- Day 1
Walking with crutches, often with a brace. Ice, elevation and straightening exercises begin.
- 2 to 3 weeks
First follow-up and wound check. Focus on full straightening and reducing swelling.
- 4 to 6 weeks
Walking without crutches for most patients. Many return to desk work or classes.
- 3 months
Good daily function. Cycling, gym strength work and balance training progress.
- 4 to 6 months
Straight-line running and early jumping drills if strength milestones are met.
- 6 to 12 months
Sport-specific training and return to cricket, football, kabaddi or other sports after testing.
Frequently asked questions
Can an ACL tear heal without surgery?
A complete ACL tear usually does not heal back into a working ligament on its own in adults, but many people can still manage without surgery. With structured physiotherapy, thigh and hip strengthening, and sometimes a brace for activity, the muscles around the knee can make up for the missing ligament. This works best for partial tears with a stable knee, and for people who do not play twisting sports or do heavy physical work. If your knee keeps giving way during daily activities, or you want to return to cricket, football or kabaddi, reconstruction is usually advised because repeated giving way can damage the meniscus and cartilage. Dr. Rai will examine the stability of your knee and look at your MRI before suggesting either path. Read more about knee pain causes and non-surgical treatment.
What is the cost of ACL surgery in Varanasi?
The cost of ACL surgery in Varanasi varies with the details of your knee, so a single figure would not be honest. The main factors are the type of graft, the fixation devices used to hold it, whether a meniscus repair is needed at the same time, the type of anaesthesia, the length of hospital stay, MRI and pre-operative tests, medicines, a knee brace, and the number of physiotherapy sessions. Shubhyash Hospital gives you a written estimate after Dr. Rai has examined you and planned the surgery, so you and your family know what to expect before admission. Ask about the cost of rehab as well, since good physiotherapy over several months is part of a successful result. Call the hospital desk on +91 93696 80496 or use the contact page to arrange a consultation.
How long does it take to recover from ACL surgery?
Recovery from ACL surgery happens in stages over several months. Most patients walk with crutches from the first day and stop using them within about 4 to 6 weeks, when the physiotherapist says it is safe. Many people return to desk work or classes in about 4 to 6 weeks and manage most daily activities within a few months. Running usually begins around four to six months if strength and control are good. Return to full sport is the longest part: the AAOS says most patients return within 6 to 12 months, and the NHS notes it can take up to a year. Rushing increases the risk of tearing the new graft. Your progress depends on regular physiotherapy and following the plan. The keyhole technique itself is explained on the arthroscopy surgery page.
When can I play cricket after ACL surgery?
Most players can return to cricket after ACL surgery somewhere between 6 and 12 months, depending on how well the knee recovers. Batting and bowling put different loads on the knee. Fast bowlers land hard on the front leg, and fielders dive, turn and sprint, so these players often need the longer end of the range. Before clearing you, Dr. Rai checks thigh strength, single-leg hop distance, balance and how confident you feel cutting and landing. Nets come first, then practice matches, and finally competitive games. The same step-by-step approach applies to football, kabaddi, badminton and basketball. Returning only because a set number of months has passed, without passing these checks, increases the risk of a second injury. Book a sports injury visit through the contact page to plan your season.
Is ACL surgery painful?
ACL surgery is not painful during the operation because it is done under spinal or general anaesthesia. Afterwards, most patients have moderate pain and swelling for the first several days, which is controlled with tablets, ice packs and keeping the leg raised. Some people also feel soreness where the graft was taken, such as the back of the thigh for a hamstring graft or the front of the knee for a patellar tendon graft. Pain usually improves steadily over the first two to three weeks. Early physiotherapy can be uncomfortable but it prevents stiffness, which is far harder to treat later. If you get a fever, increasing redness, pus from a wound, or pain and swelling in the calf, contact Shubhyash Hospital, which runs 24x7 emergency services, straight away.
What is the best age for ACL surgery?
There is no fixed best age for ACL surgery. The decision depends on how active you are and how stable the knee feels, rather than age alone. Young athletes and students who play pivoting sports usually benefit most, because they are likely to keep stressing the knee. Adults in their thirties, forties and beyond can also have ACL reconstruction if they remain active and the knee keeps giving way. In older adults with arthritis already present in the knee, the plan may be different, and arthritis care or, in some cases, knee replacement may be more relevant. In children whose growth plates are still open, special care is needed to protect bone growth, so the approach is planned carefully. Dr. Rai will discuss what suits your age, sport and goals at consultation.
Do I need a knee brace after ACL reconstruction?
A knee brace after ACL reconstruction is often used for the first few weeks, but it is not required for everyone. In the early period, a brace can protect the knee while you walk with crutches and the thigh muscle is still weak, especially if a meniscus repair was done at the same time. Later, strength, balance and good movement patterns matter more than the brace for protecting the graft. Some players choose to wear a functional brace when they first return to sport for confidence. Whether you need one, which type and for how long will depend on the surgery done and your progress in physiotherapy. Dr. Rai and the physiotherapist will tell you when to stop using it. For general advice on protecting your knees, see knee pain treatment in Varanasi.
Can I sit on the floor or use an Indian toilet after ACL surgery?
Sitting on the floor or using an Indian toilet after ACL surgery should wait until your knee bends well and the thigh muscles are strong, usually several weeks to a few months. Deep bending puts high pressure on the healing graft and on any meniscus repair. In the early weeks, use a chair at meal times, a raised bed, and a western toilet, a commode chair or a raised toilet seat. Sitting cross-legged for puja or family functions, and squatting while working in the kitchen or fields, should be brought back gradually as advised by the physiotherapist. If a meniscus was stitched, Dr. Rai may restrict deep bending for longer. Ask about these daily-life activities at follow-up, because the right timing depends on your surgery. More home tips are on the knee pain page.
Sources
General medical information on this page was checked against: