Introduction

Anterior Cruciate Ligament (ACL) reconstruction surgery is performed to replace a torn ACL and restore stability to the knee. The procedure is not the same for every patient. Orthopedic surgeons choose the surgical method based on factors such as age, activity level, severity of injury, associated damage, and patient goals. The main difference between types of ACL reconstruction lies in the graft used to replace the torn ligament and the surgical technique.

Below are the major types of ACL reconstruction surgery explained in detail.

Types of ACL Reconstruction Surgery

Autograft ACL Reconstruction :- Autograft reconstruction uses tissue taken from the patient’s own body to create a new ACL. This is the most commonly performed and preferred method, especially for young and active individuals.

Types of Autografts

Patellar Tendon Autograft (Bone-Patellar Tendon-Bone Graft) :- In this technique, the surgeon removes the middle portion of the patellar tendon along with small pieces of bone from the kneecap (patella) and shinbone (tibia).

Advantages

Strong and durable graft
Excellent stability for athletes
Faster bone-to-bone healing
Lower risk of graft failure in high-demand activities

Limitations

Pain in the front of the knee after surgery
Difficulty kneeling
Risk of patellar fracture (rare)

This option is often recommended for professional athletes or highly active patients.

Hamstring Tendon Autograft :- In this method, the surgeon removes one or two hamstring tendons (usually semitendinosus and gracilis) and folds them to create a strong new ligament.

Advantages

Smaller incision and less postoperative pain
Less discomfort while kneeling
Faster recovery of knee movement
Reduced risk of front knee pain

Limitations

Slightly slower graft healing compared to bone grafts
Possible mild hamstring weakness

This is a popular choice for young adults and moderately active individuals.

Quadriceps Tendon Autograft :- This technique uses a portion of the quadriceps tendon, sometimes along with a small bone piece from the kneecap.

Advantages

Strong and thick graft
Less anterior knee pain than patellar graft
Good option for revision surgery

Limitations

Temporary weakness in thigh muscles
Less commonly used than other grafts

This method is often chosen for revision ACL surgery or patients with previous graft issues.

Allograft ACL Reconstruction : –Allograft reconstruction uses donor tissue obtained from a tissue bank. The graft may come from the patellar tendon, Achilles tendon, or other soft tissues.

Advantages

No need to remove tissue from the patient’s body
Shorter surgery time
Smaller incisions and less postoperative pain
Faster early recovery

Limitations

Slightly higher risk of graft failure in young or active patients
Slower graft incorporation into the body
Very minimal risk of disease transmission (rare due to screening)

Allografts are commonly recommended for:

Older patients
People with lower activity levels
Patients undergoing revision surgery
Those who want a less invasive procedure

Single-Bundle ACL Reconstruction :- The natural ACL consists of two bundles (anteromedial and posterolateral). In single-bundle reconstruction, the surgeon replaces the ligament with one graft positioned to replicate the main function of the ACL.

Advantages

Technically simpler and widely performed
Reliable long-term outcomes
Shorter surgical time

Limitations

May not fully restore rotational stability in some high-demand athletes

This is the standard and most commonly performed ACL reconstruction technique.

Double-Bundle ACL Reconstruction :- This advanced technique reconstructs both bundles of the ACL separately to more closely mimic natural anatomy.

Advantages

Better rotational stability
More natural knee movement
Potentially improved performance for athletes

Limitations

More complex surgery
Longer operative time
Not suitable for all patients due to bone size and anatomy

Double-bundle reconstruction is usually considered for young athletes or individuals involved in high-level sports.

Revision ACL Reconstruction :- Revision surgery is performed when a previous ACL reconstruction fails due to graft re-tear, improper healing, or persistent instability.

Features

Careful evaluation of previous surgery
Removal of old graft and hardware if necessary
Use of a different graft type (often quadriceps tendon or allograft)
Correction of bone tunnel placement if required

Revision procedures are more complex and require experienced orthopedic surgeons.

Arthroscopic ACL Reconstruction :- Regardless of graft type, most modern ACL surgeries are performed using arthroscopy, a minimally invasive technique.

Procedure Overview

Small incisions are made around the knee
A camera (arthroscope) is inserted
Surgical instruments are used to prepare bone tunnels
The graft is placed and fixed using screws or other devices

Advantages

Less tissue damage
Reduced pain and swelling
Faster recovery
Minimal scarring

Arthroscopic surgery has become the gold standard for ACL reconstruction.

Choosing the Right Type of ACL Surgery

The best surgical option depends on several factors, including:

Age and overall health
Activity level and sports involvement
Occupation and lifestyle
Severity of ligament damage
Associated injuries (meniscus, cartilage)
Previous knee surgeries
Surgeon’s expertise

A detailed evaluation by an orthopedic specialist helps determine the most suitable graft and technique for long-term success.

Conclusion

There are several types of ACL reconstruction surgery, each designed to restore knee stability and function based on individual needs. Options include autografts such as patellar, hamstring, or quadriceps tendons, as well as allografts from donor tissue. Surgical techniques like single-bundle, double-bundle, and revision reconstruction further tailor the procedure to the patient’s condition and activity level. With modern arthroscopic methods and personalized treatment planning, ACL reconstruction offers excellent outcomes, helping patients return to daily activities and sports safely and confidently.