ACL Injury: Do You Really Need Surgery?

What Happens When You Tear Your ACL

The anterior cruciate ligament is one of four major ligaments stabilising the knee. It prevents the shin bone from sliding forward relative to the thigh bone and resists rotational forces — exactly the forces generated during pivoting, cutting, and landing in sport.

An ACL tear is typically felt as a loud pop, followed immediately by significant swelling (within 2–4 hours), and an inability to continue playing. The knee may feel unstable — as though it might "give way" if you change direction quickly. MRI scanning confirms the diagnosis and, crucially, identifies any associated meniscal or cartilage damage.

The Case for Non-Surgical Management

The ACL cannot repair itself — it lacks sufficient blood supply. However, this does not automatically mean surgery is required. Many patients, particularly older or less active individuals, achieve excellent function without reconstruction through physiotherapy and lifestyle modification.

Non-surgical management works best when:

• You do not participate in pivoting sports (football, basketball, tennis, squash)
• Your knee feels stable during your usual activities
• You are willing to modify your activity level
• MRI shows no significant associated meniscal tear

Physiotherapy focuses on strengthening the quadriceps and hamstrings to provide dynamic stability that compensates for the absent ligament.

The Case for Surgical Reconstruction

For athletes and active individuals wishing to return to sport, surgical reconstruction offers significantly better outcomes. More importantly, an unstable knee without an ACL causes progressive damage to the menisci and cartilage with each episode of giving way — accelerating the development of osteoarthritis even in young patients.

Dr. Hargovind Singh recommends surgical reconstruction when:

• You wish to return to pivoting or cutting sports
• Your knee gives way during normal activities
• You have an associated repairable meniscal tear
• You are young and active with decades of sport ahead

The Surgery Itself

ACL reconstruction is performed arthroscopically — through two or three small keyhole incisions around the knee. Dr. Singh uses either a hamstring tendon or patellar tendon graft, chosen based on your anatomy, sport, and individual factors discussed at consultation. The procedure takes approximately 90 minutes. Most patients go home the same day or the following morning.

Return to Sport

Return to competitive sport after ACL reconstruction takes 9–12 months when following a criteria-based rehabilitation programme. Dr. Singh uses objective functional tests — single-leg hop tests, strength ratios, movement quality assessments — to determine readiness. Athletes who return before meeting these criteria have significantly higher re-rupture rates. The investment in a full rehabilitation programme is the single most important factor in long-term success.