An ACL (anterior cruciate ligament) tear is one of the most common knee injuries. If your ACL is torn, your knee might feel unstable or even give out.

Our experts work together to get you back to the activities you love.

OHSU offers:

• The BEAR implant — we’re one of the few clinics in Oregon with this option
• Specialists in ACL revision surgery
• All ACL graft options
• A team approach to recovery
• Sports medicine and orthopedic experts

We focus on treating your pain, helping you function better and reducing the risk of arthritis and future injury.

Diagnosing ACL injuries

At your first appointment, your doctor will help you understand your options. You can expect to:

• Talk about when and how the injury happened
• Have your knee checked for stability and range of motion
• Review your X-rays and MRI to see the tear and check for other damage
• Discuss your activity level and goals
• Create a personal treatment plan

Most ACL injuries are complete tears. This means the ligament is torn in half or pulled off the bone. This makes the knee unstable, especially during certain activities.

What is ACL repair surgery?

ACL surgery repairs a torn ACL. The torn ligament cannot be sewn back together. It needs to be replaced or given help to heal.

OHSU offers two main approaches:

Traditional ACL reconstruction: Your doctor uses tendon tissue from your body or a donor’s to replace your torn ACL.

BEAR implant: A BEAR implant helps your body heal the torn ACL. OHSU has one of the few doctors in Oregon offering this treatment.

Your surgeon will help you decide on the best approach based on your injury pattern, activity level and goals.

When is ACL surgery recommended?

Surgery is often recommended if:

• You play sports that involve changing direction, pivoting or jumping
• Your knee gives out during daily activities
• Other knee injuries (like meniscus tears) need repair
• You want to return to high-level sports or physical work
• You are young and active

Nonsurgical treatment may work if you:

• Have a partial tear
• Have a stable knee
• Are willing to change some activities
• Can do physical therapy to strengthen your knee

How ACL repair surgery works

In traditional ACL repair surgery, your surgeon replaces the torn ligament with a graft. The graft, a piece of living tissue, comes from the patient or a donor. The surgery is done through small cuts.

Your surgeon:

• Makes small cuts in your knee
• Uses a camera to see inside your knee and remove the torn ACL
• Places the graft and fixes any other damage

The surgery takes 1 to 2 hours. Most people go home the same day.

Graft options

Our surgeons have experience with all types of ACL grafts. Your doctor will talk with you about the best option. Options include:

Patellar tendon graft: This graft takes tendon tissue from the front of your knee. It’s a good option for athletes and people who do physical work. You may have some pain when you kneel.

Hamstring tendon graft: This graft comes from the back of your thigh. It uses a smaller incision for less pain and faster recovery.

Quadriceps tendon graft: This graft comes from above your kneecap. It’s a good option for larger patients or when an ACL repair needs to be done again or adjusted (revision surgery).

Allograft: This graft uses donor tissue that has been carefully screened for disease. You are spared the discomfort of having your own tissue removed. Surgery is faster. 

The BEAR implant for ACL repair

The BEAR implant is a less invasive option that helps your body heal its own ACL. BEAR stands for bridge-enhanced ACL restoration. Instead of replacing the ligament, the implant acts as a bridge. It holds the torn ends in place while they heal back together.

Benefits of the BEAR implant:

• Your body heals its own ACL and keeps your natural knee anatomy.
• You have surgery in one area instead of two.
• Your body absorbs the implant in about 8 weeks.
• Studies show people with the BEAR implant have stronger hamstrings 2 years after surgery compared to reconstruction.

OHSU is one of the few places in Oregon with this newer FDA-approved treatment.

Revision ACL repair surgery

If you had ACL surgery and the graft failed or stretched, you may need revision surgery. Our doctors are experienced with these complex procedures.

Revision surgery uses a different type of graft than was used in your first ACL surgery. Surgeons may use special techniques to address bone loss or other complications from the first surgery.

How to prepare for ACL repair surgery

Your care team will help you make a plan before surgery. Conditioning before surgery can speed recovery.

Before surgery:

• Do physical therapy to reduce knee swelling and restore motion.
• Stop smoking at least 4 weeks before surgery.
• Arrange for a ride home.
• Set up a recovery area at home.
• Get crutches and ice ready.

Recovering from ACL repair surgery

Physical therapy is critical for ACL recovery. It can include:

• Keeping ice on the surgery area
• Walking with crutches at first
• Exercises to help with strength, motion and balance
• Specific exercises for your sport

Your doctor will talk with you about the right time to return to sports or vigorous activity. In general, your knee needs to be strong and move easily with no pain.

When to call your doctor after ACL repair surgery

• Fever over 100 degrees
• Surgery area turns redder
• Surgery area leaking fluid
• Sudden increase in pain
• Chest pain or trouble breathing
• Calf pain or swelling

Learn more about ACL repairs

• ACL Injuries, American Academy of Orthopaedic Surgeons
• New technique for ACL repair taps body’s own healing power, OHSU News