ACL Repair

Anterior cruciate ligament (ACL) injuries are common among athletes and individuals taking part in high-impact activities. Traditionally, ACL reconstruction has been the standard surgery for treating a torn ACL since the 1980s. However, there has been recent work in the redevelopment of ACL repair techniques, which offer specific advantages over reconstruction in selected patients. This webpage explores the benefits of ACL repair and why it may be a preferable option in certain cases.

1. Preservation of Natural Tissue

One significant advantage of ACL repair is the preservation of your natural ACL tissue. Unlike reconstruction, which involves removing the torn ACL and replacing it with a graft, repair techniques aim to reattach and reinforce the torn ligament. By preserving your native ACL, repair helps maintain the integrity and function of the original ligament.

2. Faster Recovery Time

Compared to ACL reconstruction, which typically involves a more extensive surgical procedure and longer rehabilitation process, ACL repair often leads to a faster recovery time. Since repair techniques do not require the creation of a graft or tendon harvesting, the surgery is less invasive. This reduced surgical trauma translates into quicker healing, reduced postoperative pain, and a quicker return to normal activities.

3. Reduced Risk of Donor Site Morbidity

ACL reconstruction involves harvesting a graft from a different area of the body, such as the patellar tendon, hamstring, or quadriceps tendon. While effective, graft harvesting can result in donor site injury, including pain, weakness, or complications specific to the graft site. ACL repair eliminates the need for graft harvesting, reducing the risk of complications associated with donor site injury.

4. Lower Rates of Osteoarthritis

Studies have suggested that ACL repair may offer potential advantages in terms of reducing the risk of long tern arthritis. Preserving your natural ACL may contribute to maintaining the biomechanical properties of the knee joint, potentially decreasing the likelihood of long-term degenerative changes. Minimizing the risk of arthritis is particularly crucial in younger patients who have a longer lifespan and increased activity levels.

5. Cost-Effectiveness

ACL repair can be a cost-effective alternative to reconstruction. The potential for faster recovery and an earlier return to work or sports activities may result in decreased indirect costs associated with rehabilitation and time away from work.

6. Suitable for Select Patient Profiles

ACL repair is not appropriate for all patients, and careful patient selection is crucial. It is typically recommended for partial tears, high tears in young patients with open growth plates, and cases where the torn ACL has good tissue quality for repair. The repair is ideally performed within the first 3-4 weeks after injury. Skiing injuries often result in high ACL tears, suitable for repair. Consulting with an experienced orthopaedic surgeon is essential to determine if ACL repair is the appropriate choice for an individual patient.


While ACL reconstruction remains the gold standard for many ACL injuries, ACL repair offers distinct advantages in selected patients. By preserving the patient’s native ACL, reducing surgical trauma, and potentially lowering the risk of long-term complications, ACL repair provides a viable alternative to reconstruction. However, careful patient selection and consultation with an experienced orthopaedic specialist are crucial to determining the most suitable treatment approach for each individual case. Mr Bowler has been performing ACL repairs since 2017 and was fortunate to learn from one of the pioneers of the modern repair with Dr. DiFelice in New York. Read his post here.

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