Torn ACL: How reconstructive surgery gets athletes back in the game
March 25, 2025
The injury can happen in an instant.
For Dallas Mavericks point guard Kyrie Irving, his left knee extended backward as he was fouled while driving to the basket during the first quarter of the March 3 game against the Sacramento Kings.
For University of Southern California Trojan standout JuJu Watkins, her right knee injury came during a first quarter drive to the basket in the second round of the NCAA Tournament on March 24 against Mississippi State.
The result was the same for both basketball stars, and it’s one that no athlete wants to hear: a torn anterior cruciate ligament (ACL) – a season-ending injury that is particularly prevalent in basketball, football, and soccer. It typically involves sudden stops while running, jumping, pivoting, and making quick directional changes along with blunt-force contact.
ACL tears are unfortunately common, making up about 40% of all reported sports-related injuries. Not only are they treatable, but they also carry the potential for a full recovery and a return to sports after surgery and an extensive regimen of physical therapy and rehabilitation.
The ACL is a strong band of tissue inside the knee that stabilizes the joint and connects the thighbone to the shinbone. This approximate inch-long ligament is fully encased by the knee joint and has a limited blood supply, though it is surrounded by synovial fluid that lubricates and cushions the joint.
When an ACL ruptures, the body tries to send blood to the area to start clotting and healing, but the synovial fluid dissolves it. That means many people need reconstructive surgery and dedicated physical therapy to regain full knee function.
Despite this complexity, most people can fully recover back to play within 7 to 12 months after an ACL tear. Professional athletes, such as retired U.S. soccer star Megan Rapinoe, Olympic skier Lindsey Vonn, and Boston Celtics center Kristaps Porzingis, have all successfully recovered from ACL tears and returned to their sports.
Nathan Boes, M.D., Edward Arrington, M.D., and UTSW’s Orthopaedic Surgery and Sports Medicine team perform hundreds of ACL reconstructions each year and serve as the specialists for high school, collegiate, and professional sports teams, including FC Dallas and Dallas Trinity, the area’s first female pro soccer club.
UFC star returns to the ring after treatment for ACL injury
UFC fighter Kennedy Nzechukwu, right, underwent reconstructive surgery on his left knee and spent eight months in rehab before returning to the sport he loves.
What are the signs of an ACL tear?
Most ACL tears or strains are caused by a sudden pivot or cutting motion with a planted foot. In Kyrie Irving’s case, a sudden stop can cause the knee to hyperextend or bend unnaturally, stretching and tearing the ligament.
If you experience a twisting injury or take a blow to the knee, such as a hard fall or a direct hit from a sports opponent, watch for these telltale signs of an ACL tear:
- Popping sound
- Clicking sensation within the knee
- Immediate swelling of the knee
- Knee pain or instability (buckling or giving out)
- Difficulty moving the knee
- Inability to bear weight on the leg
In most cases, a total ACL tear will not heal on its own. Don’t delay care if you have any of these symptoms during activity. Eventually the swelling will subside, and the knee will tolerate more weight, but many will experience a knee that doesn’t “feel normal,” especially when you resume sporting activity.
Left untreated, a torn ACL increases the risk of knee instability and long-term pain and puts you at risk for further injury to meniscus and cartilage, which can lead to degenerative changes in the knee.
Related reading: High school athletes' most common injuries – and how to avoid them
How is an ACL tear treated?
ACL injuries are diagnosed by a clinical exam and imaging, such as an MRI. An orthopedic sports medicine surgeon can provide treatment options that will give you the best outcomes depending on the extent of the injury and your goals for returning to play. Regardless of the option you choose, personalized physical therapy will play a big role in regaining knee strength, function, and stability.
Reconstructive surgery
An estimated 400,000 ACL reconstructions are done every year in the U.S. Active people who want to get back in the game will have better outcomes with reconstructive surgery to restore stability, avoid additional injury to the knee, and support essential functions like pivoting and running.
In a knee ligament reconstruction, the surgeon replaces the torn ligament with a healthy tissue graft. There are two graft options:
- Allograft: Donated from a cadaver, this tissue comes from the hamstring, patella (kneecap) tendons, or Achilles’ tendon.
- Autograft: This option transplants a small amount of tissue from the patient’s own quadriceps, hamstring, or patellar tendons. The surgeon will help you decide the best option for your knee based on your age, goals of care, and sports activity level.
ACL repairs and reconstructions are single-day procedures; most patients do not need to spend the night in the hospital. You will be under anesthesia during the surgery, which is done through small incisions in the knee and at the donor ligament site, if needed.
The risk of reinjury after reconstruction in athletes is 5% to 20%, with youth at higher risk than adults. During your clinic visit, the surgeon will discuss risk factors of reinjury and may suggest small modifications to surgery to minimize this risk based on your leg alignment, anatomy, MRI findings, and future activity goals.
As soon as possible after you wake up from anesthesia, your recovery begins. The UTSW Physical Medicine and Rehabilitation team will guide you in starting to move your knee and set you up with a physical therapy schedule to work toward your goals.
Nonsurgical options
Although less common, non-operative management is another option for ACL injuries for various patients. This is done with activity modification, anti-inflammatory medications, bracing, and physical therapy.
Why does recovery take so long after ACL reconstruction?
We get it – you want to get back to your sport as soon as possible, and seven months to a year of recovery can seem like a lifetime when you are eager to play. But ACL tears are considered “season-ending” for a reason. Your body needs time for the ligament to heal and restabilize to reduce the risk of future injury. After one big injury, you are at a higher risk than the average athlete to develop another.
For the first month after surgery, you will be managing inflammation, which is the body’s natural healing process. Ice packs and/or cryotherapy can help manage pain and swelling. Physical therapy will help strengthen the knee and help you regain your motion after surgery.
You are not alone in your ACL surgery recovery. At UTSW, our sports medicine team will be there to get you through the rehab process, which involves:
- Recovering full range of motion
- Strengthening the muscles around the knee
- Returning to light jogging (around three months after surgery), followed by running and sprinting
- Beginning to jump, pivot, and move laterally
- Return-to-sport testing to make sure you’re ready for competition
People often discount the emotional toll of sitting on the sidelines during an injury. If you are feeling sad or anxious about your recovery, we will connect you with a board-certified behavioral health expert to help support your mental health.
Peak performance won’t return right away. Increase your effort gradually, and follow your personalized care plan to reduce the risk of re-injury or a new injury. The Dallas Mavericks posted on social media that the team expects Irving to return to the court “stronger than ever” after his recovery.
Here at UTSW, we use the most advanced rehabilitation technologies and techniques and focus on your recovery. We help our patients approach their rehab with the right attitude and embrace the specialized care they receive with our Orthopedic Sports Medicine team.
To talk with an expert about ACL treatment and recovery, make an appointment by calling 214-645-3300 or request an appointment online.
