Reconstruction

• A complete ACL reconstruction is the most commonly performed ACL procedure, according to the AAOS. Tissue obtained from elsewhere in the body, called a graft, replaces the torn ACL. After the graft heals, physical therapy can help the new tissue function as a new ACL. The graft may come from the patient himself (from the hamstring or another area of the body) or from a donor.
  
  

Extra-Articular Procedures

• Extra-articular surgery means "outside the joint." This procedure differs from other ACL surgeries because it does not actually focus on restoring the ACL and repairing the tear. In an extra-articular procedure, the iliotibial band (a portion of the tendon of the knee) is secured outside of the knee joint to stabilize the knee, thus taking over the stabilizing function that the ACL would normally perform. Although it does not work as well as the ACL because it is external to the knee, it does work and avoids the repair of the ACL and the accompanying months of physical therapy that usually follow a complete ACL reconstruction. Because it provides less support and may interfere with the range of motion and normal function of the knee, this procedure typically is not performed on young or active people who don't want to modify their physical activity.
  
  

Direct Repair

• Direct repair is a simple surgical procedure in which the torn ends of the ACL ligament are attached to each other and held together by sutures. Once attached, the ligaments are supposed to fuse together on their own and heal themselves. Unfortunately, this does not always happen properly, and the ligaments often do not fully heal and reattach, so this procedure is not commonly performed.