ACL Tear & Reconstruction in Athens

What the ACL is

The anterior cruciate ligament (ACL) sits in the centre of the knee. It holds the shin bone in place and steadies the knee during twists and changes of direction. That is why it is often injured in football, basketball and skiing.

How to tell it is torn

A pop, heard or felt, at the moment of injury.
Fast swelling, within a few hours.
Pain and trouble carrying on with the activity.
Later, a feeling that the knee gives way on twists or stairs.

The diagnosis is made by clinical examination and confirmed with an MRI scan, which shows any damage to the menisci or cartilage as well.

The first days after the injury

Stop the activity. A knee that swelled quickly needs to be examined.
Ice for 15 to 20 minutes, several times a day, with the leg raised.
Crutches, if walking hurts or you do not trust the knee.
Avoid twisting and sport until you have been examined.
Move the knee gently. Complete rest makes it stiff.

An MRI scan is not urgent on day one. A clinical examination by an orthopaedic surgeon, though, is worth having soon.

Injuries that come with it

The ACL is rarely injured alone. The same injury may include:

A meniscus tear, which can often be stitched in the same operation. Read more about the meniscus.
A sprain of the medial collateral ligament, which usually heals with a brace and physiotherapy.
Bone bruising, visible on the MRI, which fades over a few months.
Cartilage damage, less often.

These injuries affect both whether surgery is done and when.

Is surgery always needed?

The ACL usually does not heal by itself. That does not mean everyone needs an operation. The decision depends on your age, the sports you play, how unstable the knee is and whether other structures are damaged.

People with modest demands and a stable knee often do well with targeted physiotherapy. Those who want to return to pivoting sports, or whose knee keeps giving way, usually benefit from a reconstruction.

ACL tears in teenagers and after 40

In teenagers, re-tears are more common and the growth plates of the bones call for a special technique. Rehabilitation here must not be rushed, and the return to sport is judged strictly by criteria.

After 40, age alone does not rule out surgery. An active person who skis, plays tennis or football and has a knee that gives way benefits as much as a younger one. Someone with a stable knee and gentle activities, on the other hand, can stay with treatment that does not involve surgery.

Prehabilitation: the work before surgery

Surgery is not done on a swollen, stiff knee. In the first weeks we work on three goals: the swelling goes down, the knee straightens fully and the quadriceps wakes up again.

People who reach surgery with good movement and strong muscles recover more easily. For some, this period shows something else too: that their knee is stable enough for the life they lead, and that they do not need an operation.

ACL reconstruction

The operation is done by arthroscopy. The torn ligament is replaced with a graft, usually taken from the patient’s own tendons. The graft passes through small tunnels in the bone and is fixed where the old ligament used to be.

Dr Skotidis presented work on the all-inside technique and its reinforcement with an internal brace at the EFORT Congress in Vienna. If there is a meniscus tear too, it is treated in the same operation.

Choosing the graft

The new ligament is usually made from one of your own tendons. Each option has its pros and cons.

Hamstring tendons. A small incision and less pain at the front of the knee. They may leave slight weakness in bending.
Patellar tendon. It heals bone to bone and is often used in athletes. It can cause discomfort when kneeling.
Quadriceps tendon. A strong graft, used more and more.
Allograft. From a donor. Usually avoided in young athletes, because it has a higher re-tear rate.

The choice is made together, based on your sport, your age and your job.

The day of surgery

ACL reconstruction is done under spinal or general anaesthesia and usually takes an hour to an hour and a half. The hospital stay is short, often one night. You leave on crutches, with instructions on ice and the first exercises, which start the very next day.

In the first two weeks the goal is a calm knee that straightens fully. Strength comes later.

The return to sport

Recovery comes in stages and asks for steady work.

First weeks: control of swelling, full straightening, waking up the quadriceps.
Months 2 to 4: strengthening, balance, cycling, swimming.
Months 4 to 6: straight-line running and gradually more complex drills.
Months 9 to 12: return to pivoting sports, once you pass specific strength and function tests.

The return is judged by criteria, not by the calendar alone. Rushing raises the risk of a new tear.

The return-to-sport tests

“Six months have passed” is not a criterion. Before a return to pivoting sports we check:

Quadriceps and hamstring strength at 90% or more of the healthy leg.
Single-leg hop tests, at the same ratio.
A knee with no swelling and full movement.
Good technique in landing and changing direction.
Mental readiness. Fear counts as much as strength.

Studies show that people who return before nine months have a clearly higher risk of a new tear.

Preventing a new tear

Neuromuscular warm-up programmes, with balance, strength and landing drills, have been shown to reduce ACL injuries. They take 15 minutes and are done before every training session.

After a reconstruction they are worth turning into a lasting habit. They protect both the operated knee and the healthy one, which is equally at risk.

Experience from high-level sport

Dr Skotidis was a member of the medical team of Panionios FC and worked as a doctor at Adidas Runbase. Daily work with athletes teaches something simple: the goal is a knee you trust again.

Myths and facts

Myth: “A torn ACL always means surgery.” Fact: It depends on how stable the knee is and the life you lead.
Myth: “I will be playing again in six months.” Fact: For pivoting sports the safe horizon is nine to twelve months, and it goes through tests.
Myth: “The new ligament is stronger than the old one, so it will not tear again.” Fact: It can tear again, especially if the return is rushed.
Myth: “I can walk, so nothing is torn.” Fact: Most people walk normally. The problem shows on twists.

What to ask your surgeon

Do I need surgery, or can I try rehabilitation first?
Which graft do you suggest for me, and why?
Is the meniscus or the cartilage damaged?
When is the right time for the operation?
By which criteria will I return to my sport?

Common questions

Can I walk with a torn ACL?

Yes, most people walk once the swelling goes down. The problem shows up mainly on twists and sudden changes of direction.

When should the operation be done?

Usually not straight away. We wait for the swelling to settle and for the knee to move well again. The right moment is decided at the examination.

What happens if I do nothing?

A knee that gives way again and again can damage the menisci and the cartilage over time. That is why a proper assessment is worth it, even if you choose treatment without surgery.

When can I drive after the reconstruction?

Usually in four to six weeks for the right leg, sooner for the left leg in an automatic car. You must be able to brake without pain or hesitation.

Do I need a brace?

Not always. It depends on the technique and on whether a meniscus repair was done too. You will know before the operation.

Can I go to the gym if I do not have surgery?

Yes. Cycling, swimming and straight-line strength work are safe and useful. Sports with twisting and jumping are the ones that put the knee at risk.