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ACL Reconstruction

Anterior Cruciate Ligament (ACL) Reconstruction Overview

The anterior cruciate ligament (ACL) is one of the four main ligaments responsible for stabilizing the knee. The other ligaments include the posterior cruciate ligament (PCL), medial collateral ligament (MCL) and posterior lateral complex (PLC). The ACL is located at the front of the knee joint (anterior) and crosses (cruciate) in front of the PCL. Responsible for assisting with stability during rotational movements and twisting, the ACL is the most commonly torn knee ligament. Athletes are more prone to an ACL injury since they are heavily involved in running, acceleration and deceleration, and sudden cutting movements. When an ACL injury or tear occurs and requires surgery, an ACL surgery may be recommended. Highly experienced in ACL reconstruction surgery, Dr. Brian Waterman, knee surgeon, can help professional athletes and the general, active population return to the activities they love following an injury.

In most cases, an ACL injury occurs as a result of an acute traumatic event. Over 70% of these injuries are non-contact, meaning the athlete injures themselves without contact from another player. Most patients experience a popping sound at the time of the ACL injury and notice sudden swelling and pain in the affected knee. The injury is followed by a sense of instability and difficulty with range of motion in the knee.

When an injury occurs to this ligament, an ACL reconstruction is typically recommended by Dr. Waterman. The ACL has a poor blood supply and due to the general anatomy of the knee, the ligament does not heal naturally on its own. The decision to proceed with surgery is dependent on the age and desired activity level of the injured person. In most cases, reconstruction is required if the patient wishes to return to high level contact, cutting or pivoting sports. ACL surgery stabilizes the knee while lowering the risk of future arthritis or meniscus tear.


Dr. Waterman typically treats the ACL in an arthroscopic procedure. This procedure is less invasive and involves the use of tiny incisions, a camera and small surgical instruments to view and assess the knee and surrounding area. Dr.Waterman will begin the torn ACL surgery by viewing the knee with the camera and determining the extent of damage. The ligament must then be reconstructed and not just repaired because of its limited healing ability. Dr.Waterman will first remove the ligament’s damaged ends. He will then position a certain replacement graft in the former ACL site and attach it to the thigh and lower leg with adjustable buttons or screws. The goal of the ACL reconstruction is to place and secure the replacement graft precisely in the right location to reconstruct the damaged ligament.

There are two main types of grafts used in an ACL reconstruction, including:

  • Autograft: The donor tissue is harvested from the patient’s quadriceps tendon, patella tendon or hamstring tendon.
  • Allograft: The donor tissue is taken from a tissue bank.

The best graft option is determined by the age of the patient and desired activity level and is discussed during you pre-operative appointment.

Recovery and Rehabilitation after ACL Reconstruction

Patients will be placed in a knee brace and instructed to begin an ACL rehabilitation program immediately following the ACL surgery. Crutches are recommended for approximately two to four weeks following the procedure and a functional style of brace may be used for the first year after returning to activities. Patients can expect a full recovery and return to sports activities between six to nine months in the vast majority of cases.

At a Glance

Dr. Brian Waterman, MD

  • Chief & Fellowship Director, Sports Medicine, Wake Forest
  • Team Physician, Wake Forest University, Chicago White Sox
  • Military affiliation/Decorated military officer and surgeon
  • Learn more

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