ACL Surgery


Minimally Invasive, Arthroscopic Assisted, Anatomical Anterior Cruciate Ligament (ACL) Reconstruction (Anteromedial Portal Technique)




1. What is the ACL (Anterior Cruciate Ligament)?

The ACL is one of four main ligaments of the knee that connects the femur to the tibia. The ACL's role is to stabilize your knee during quick start/stop and pivoting/cutting movements. 

2.Do I need ACL surgery?

ACL reconstruction surgery stabilizes your knee and allows athletes to return to sports, especially the ones requiring cutting and pivoting (like soccer, football, rugby, ultimate frisbee, hockey, and basketball)or landing (volleyball, gymnastics, track & field, and skiing). 

3. What happens if I don't have ACL surgery? 

Athletes who return to play sports or active patients during daily activities are at risk of creating meniscal tears (shock absorbers in your knee)and cartilage defects (lining of your knee) potentially leading to early onset arthritis in the knee. 

4. How long is the surgery? 

ACL reconstructive surgery typically lasts about 1 hour and a half, depending on whether other procedures need to be performed at the same time (meniscal repair, cartilage repair). 

It is an outpatient surgery, which means you get to go home the same day. 

5. Is the surgery painful? 

Typically, the procedure is well tolerated by most patients. You will see the Anesthesia doctor prior to your surgery to discuss the option of regional anesthesia - freezing of the nerves in your mid-thigh (adductor canal regional block), much like freezing when you go to the dentist. You have the option of having the freezing in your groin (femoral nerve block) but this may affect the function of your quadriceps post-surgery. 

The regional nerve block is in addition to your general anesthetic - you go to sleep during the duration of your surgery. 

Dr. Nguyen will also give you a post-surgery folder on the day of the surgery with a prescription for pain medication, anti-inflammatory and antibiotics to take after your procedure. 

6. How are the 2 hamstring tendons (gracilis & semitendinosus) harvested? 

Through a small incision at the front of the knee. There are 2 remaining hamstring tendons (semimembranosus & biceps femoris) to strengthen during the rehabilitation phase. 

Other graft options are the bone patella bone (BTB) graft, the quadriceps tendon, and a donor allograft. Please ask Dr. Nguyen about the pros/cons of each graft.

7. What happens on the day of the surgery? 

Please remember not to eat or drink (even water) after midnight the evening before your surgery. 

a. Please arrive 3 hours prior to your surgery. 

b. Sign in at the registration desk at the front of the hospital with the registration clerks 

c. Go to Day Surgery where the nurses will greet and prepare you for your procedure. 

d. The Anesthesia doctor and the operating room nurses will accompany you to the Operating Room

e. Surgery takes about 1 hour and half

f. You will then be transferred to the Post-Anesthetic Care Unit for about 1 hour for observation/monitoring. An X-ray of the your knee will be taken at this time. 

g. A porter will transfer you back to Day Surgery to go over discharge details with the nurses for about 1 hour. 

They will explain Dr. Nguyen's discharge folder in detail which includes the return appointment date/time (on the business card at the front of the folder), how to contact Dr. Nguyen, discharge instructions and what to expect for the next 10 days after surgery, your prescription for pain medication, antibiotics, and anti-inflammatories, and the rehabilitation protocol to give to your therapist. 

h. Unless your had a cartilage repair done at the same time as your ACL reconstruction, you may put weight on your operative leg with the hinge brace locked in full extension. You may use crutches for balance and comfort. 

i. Dr. Nguyen will call you the next day to see how you are doing and answer any questions you may have. 

j. Dr. Nguyen's Clinical Assistants have given you a return appointment for suture removal 8 days after surgery. 

Dr. Nguyen will go over the details of your ACL surgery at that time and show you the arthroscopic pictures of your procedure. 


Click on the education links below for more information on your upcoming ACL surgery:


1. General Information on ACL Reconstruction

2. The knee physical exam by Dr. Nguyen 

3. Sports Medicine Review - the knee 

4. Dr. Nguyen presenting on the knee at the 2018 University of Toronto Sports Medicine Conference

5. Video Animation of ACL Reconstruction using a Hamstring Autograft

6. Video animation of Sports Medicine surgical techniques

Clinical example - Hamstring ACL Reconstruction

Normal Knee Anatomy


ACL Footprint


Femoral and Tibial Tunnels

Anteromedial ACL bundle
Posterolateral ACL bundle

(photos courtesy of Dr. Freddie Fu)

Anatomic placement of ACL tunnels

Arthroscopic Views of ACL surgical steps

Anatomic localization of ACL origin


Accessory anteromedial femoral tunnel drilling


Femoral suspensory fixation


ACL Femoral Socket Length Maximization

ACL Femoral Socket Length Maximization

ACL Tibial Tunnel Fixation - Sleeve + Interference Screw 4 strands tensioning


ACL Post-Op X-rays


Post ACL surgery incisions



2 small arthroscopy incisions: suture removed 8 days after surgery 1 anteromedial portal incision: suture removed 8 days after surgery 1 harvest/procedure incision (arrow) : dissolvable suture, trimmed 8 days after surgery