ACL Tear Repair

ACL Tears, MCL Tears, PCL Tears, LCL Tears

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Getting back on your feet after an anterior cruciate ligament (ACL) injury may require physical therapy alone or in combination with knee surgery. Duke knee specialists combine the latest advances in ACL surgery with the knowledge and expertise of knee-specific physical therapists. We know you want to return to your sport or exercise routine as soon as possible, and we do our best to help you achieve your goal safely.

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Do You Need ACL Surgery?

Age and Activity Level
When the anterior cruciate ligament (ACL) is torn or stretched out of shape, it leads to knee instability. This will feel like your knee is buckling or giving way, particularly with activities that involve pivoting or cutting. If you’re older, sedentary, and engage in mostly straight-line activities like cycling or jogging, physical therapy may be all you need. Younger people who want to remain active or return to jumping, cutting, or twisting activities will benefit from ACL surgery combined with physical therapy before and after surgery.

Thorough Exam Determines Extent of Injury
A thorough examination, including X-rays and MRI, will determine if you suffered a knee ligament or another knee injury. If it’s an isolated MCL, PCL, or LCL ligament injury, knee surgery may not be necessary. Our experience shows that when these injuries occur in isolation, they often can heal on their own better and faster with knee bracing, early motion, physical therapy, and anti-inflammatory medication. When these injuries are combined with an ACL injury, surgery may be recommended.

Duke Orthopaedics

Duke Health orthopaedic clinics are located throughout the Triangle. In-person and virtual appointments are available.

ACL Surgery

Most of our ACL surgeries are performed using regional nerve blocks, which means you don't need to be intubated to receive general anesthesia. This approach is safer, speeds your recovery, and ensures you experience less pain.

Knee Arthroscopy

This procedure is used to evaluate knee pain and to perform ACL reconstruction surgery. This minimally invasive approach uses small incisions through which a thin, lighted tube with a camera at its tip -- called an arthroscope -- is inserted to reach the knee. ACL surgeons use donor tissue or your own quadriceps, patella tendon, or hamstring tendons to reconstruct your ACL. Knee arthroscopy has proven to be a safer alternative to open knee surgery and promotes faster recovery.

Bridge Enhanced ACL Restoration (BEAR) Procedure

This new, minimally invasive surgery does not require graft tissue. Your surgeon uses an arthroscope to confirm that enough ACL tissue is available for repair. The torn ends of the ACL are stitched and secured back to the attachment point. A BEAR implant, which looks and feels like a marshmallow, is injected with your blood and placed in the in the gap. Your body absorbs the implant over time and replaces it with new tissue. To undergo the BEAR procedure, you must be at least 14 years old, have sufficient tissue at the site of the tear, and be able to undergo surgery within 50 days of the injury. 

Bridge-enhanced ACL repair (BEAR) is a new FDA-approved procedure that allows a torn ACL to heal itself and does not require graft tissue to be taken from another part of the body. Duke Health is one of the few centers in the U.S. to offer the BEAR procedure.

When to Seek Treatment

Your knee relies on four major ligaments to keep it stable.

  • The ACL and the posterior cruciate ligament (PCL) are in the center of your knee. The ACL prevents the knee from sliding forward, and the PCL stabilizes the knee from backward movement.
  • The medial collateral ligament (MCL) controls stability of the inner (medial) knee. The lateral collateral ligament (LCL) stabilizes the outer (lateral) knee.

When to Make an Appointment
A popping sensation and sound with knee swelling during physical activity probably mean you’ve torn your ACL or had another knee injury. You should seek prompt medical attention. 

Visit Duke Orthopaedics Urgent Care
Our convenient orthopaedic urgent care clinic is open seven days a week. Get fast service with no long waits and no unnecessary exposure to illness. No appointment is needed, and walk-ins are welcome.

Physical Therapy for ACL Injuries

In many cases, you can receive physical therapy, injury treatment, and follow-up care all at one convenient location.

Before Your ACL Surgery

You will start knee-specific physical therapy immediately. Physical "prehab" prepares your knee for ACL surgery and ensures you have a faster recovery. If you’ve torn your MCL, PCL, or LCL, it may be all you need to heal the ligament.

After Your ACL Surgery

After surgery, your physical therapists work on strength and conditioning of your knee. Functional movement screening, developed at Duke, gives your doctor objective measurements of your recovery and helps them determine when you can safely return to your normal activities. This minimizes the risk of re-injury.

Why Choose Duke

A Team of Knee Specialists
Duke knee specialists include primary care sports medicine specialists, orthopaedic physician assistants, ACL surgeons, and physical therapists who specialize in knee injuries associated with specific sports. We understand how pivoting and sudden stops and starts lead to torn ACLs and how to strengthen your knee to minimize your risk of re-injury. 

You Benefit from Our Ongoing Research and Innovation
Duke Orthopaedics pioneered several surgical breakthroughs, including novel fracture repairs and advanced surgical techniques.

  • Our surgical success is based on decades of ongoing Duke research.
  • We are one of a handful of centers in the region to perform the BEAR procedure, a promising, new approach to ACL repair.
  • We use sophisticated tools to study patient outcomes, measure surgical success, and fine-tune our techniques to ensure you have the most options and experience the best outcome. 

The Right Graft for Your Injury
Our knee surgeons rely on extensive Duke research and years of experience performing these surgeries when recommending which graft will work best for you. Graft recommendations take into consideration the type of athlete you are, your age, and previous injuries. Our goal is to recommend a graft that minimizes your pain and maximizes your recovery and performance after ACL reconstruction surgery.

Best Orthopaedic Hospital in North Carolina

Where you receive your care matters. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our orthopaedics program is nationally ranked, and the highest-ranked program in North Carolina, according to U.S. News & World Report for 2023–2024.

This page was medically reviewed on 02/02/2023 by