How soon after injury ACL should be reconstructed and why?

Injuries around the knee joint involving ACL are often high velocity injuries associated with damage to the other soft tissue structures, bone contusions, meniscus injures and sometimes avulsion fractures which leads to bleeding inside the joint space (haemarthrosis) causing diffuse swelling and pain.

ACL reconstruction is preformed once the swelling and inflammation has been subsided which usually takes around 2 to 3 weeks with proper RICE (rest,  elevation, ice, compression) protocol.

Complete ACL tears require reconstruction using hamstings/patella tendon(BTB) grafts where as incomplete or partial ACL tears can be kept under observation since there is potential for the native ligament to heal on its own.

On the other hand early surgery is recommended provided there is minimal swelling since this will prevent early muscle wasting and knee stiffness and lead to fast recovery.

Similarly avulsion injuries of ACL are treated as intra-articular fractures and must be fixed early for better bone to bone healing and early rehabilitation as the avulsed fragment may lead to locking of the knee and cause knee stiffness.

An ACL injury is classified by the amount of injury to the ligament:

• Grade I: a partial ACL tear
• Grade II: near complete ACL tear
• Grade III: a complete ACL tear – the ligament is non-functional

Depending on the patient’s age, activity level and grade of tear the treatment options are decided accordingly.