Is ACL repair same as reconstruction? ACL Repair vs. Reconstruction: Key Differences, Pros & Cons, and Recovery

Last updated on June 23rd, 2025 at 12:54 pm

• 🔹 ACL repair preserves natural ligaments; reconstruction replaces them.
• 🔹 Fiber Tape Internal Bracing improves repair success rates.
• 🔹 Reconstruction has a higher arthritis risk long-term.

ACL reconstruction vs repair.

When a ligament in your knee breaks, say you have an ACL ligament injury, two types of surgeries are performed: ACL reconstruction surgery and ACL repair.

The ACL, or Anterior Cruciate Ligament, is the most common ligament damaged in athletes; among them, the highest rates of recurrent ACL ruptures were among male football players, female gymnasts, and female soccer players¹.

ACL Repair vs. Reconstruction: Key Differences Explained

When your ACL is torn, there are two main types of ACL surgery: ACL repair and ACL reconstruction. Both procedures involve removing the damaged ACL and then either repairing or reconstructing the ACL.

However, there are some differences between the two procedures. What are they?

1. How ACL Repair Works: Sutures vs. Reconstruction’s Graft Technique

So, let us first learn what ACL repair is. As the term suggests, the injured or torn ligament is rejoined surgically; it involves repairing the torn ligament with sutures.

However, this is only possible when the ligament is repairable, i.e., if the MRI suggests that the ligament is a partial tear or high-grade partial tear.

Ligament reconstruction is a different surgical procedure. If your ACL is not repairable, i.e., if the MRI shows a complete tear, the doctors will remove and reconstruct your old ACL by taking a graft from the hamstring tendon.

The hamstring muscle is on the back of the thigh; when inserted into the knee bone, it forms the hamstring tendon at this insertion point.

Since the advent of Fibre Tape Internal Bracing, the number of ACL primary repair surgeries has increased worldwide. Your torn ACL is repaired in primary repair, and Fiber Tape Internal Bracing protects the repair.

2. ACL Surgery & Arthritis Risk: Why Reconstruction Increases Long-Term Damage

Knee ligament reconstruction is associated with a higher risk of developing knee arthritis than ligament repair.

Why? Let’s find out.

Our ligaments, including ACL and PCL knee ligaments, have a natural supply of nerve fibres and blood vessels, which is crucial for nourishing ligament and joint cartilage. A healthy blood supply is essential to prevent knee arthritis from developing in the future.

In the reconstruction procedure, as the old torn ligament is completely removed, we also lose the original nerve fibres and blood vessels. Nerve fibres and blood vessels take much time to develop, increasing the risk of knee arthritis.

On the contrary, there is a lower risk of arthritis in ACL repair as the natural ligament, its nerves, and blood vessels are preserved. This can be a case where the ACL tear is on the femur (thigh) bone; in an early case, the primary repair is preferred.

In primary repair, your old torn ACL is completely repaired without needing a hamstring tendon graft. This way, your nerve fibres and blood vessels remain safe, resulting in the almost natural healing of the repaired ACL. 

3. ACL Repair Success Rates: How Fiber Tape Internal Bracing Reduces Failure Risk

ACL repairs used to have a very high failure rate. Also, ligamentisation takes six months in the reconstruction procedure, meaning you must wait six months to start exercises and get back to running. Five criteria must be met after ACL surgery to initiate running.

However, the fibre tape internal bracing technique can drastically reduce these risks.

Nowadays, in ACL repair procedures, the repaired ligament is protected with fibre tape internal bracing, which has a very high success rate. After ACL repair, you feel very confident.

Its nerves and vessels are intact, and the chances of future arthritis are significantly less. 

However, if a ligament tear is complete and not completely repairable, doctors opt for ACL augmentation.

In this procedure, the surgeon tries to repair the torn knee ligament as much as possible and also constructs another ACL from the hamstring tendon.

When Is Fiber Tape Internal Bracing Used? (3 ACL Tear Scenarios)

Depending on the degree of ACL injury and whether it is an early or late case, there are three options:

1. Either ACL repair with Fibre Tape or an internal Bracing procedure is performed for a partial ligament tear.
2. In a high-grade partial tear, ACL repair with ACL augmentation with Fibre Tape Internal Bracing with the hamstring tendon is done.
3. In a late case and complete ACL tear, doctors opt to do ACL reconstruction with Fibertape Internal Bracing. 

In all three cases, you can return to the sport because of Fibre Tape Internal Bracing. If your MRI shows a partial tear, a high-grade partial tear, or the ACL stem is visible, ACL repair with Fibre Tape Internal Bracing is the best operative technique.

Where your ACL is completely healed, tendons need not be removed. This is primary ACL repair, and its results are the best.

ACL Repair vs. Reconstruction: Pros, Cons, and Which Surgery Is Right For You

While both procedures offer similar outcomes, each has its own pros and cons. ACL repair provides some advantages over ACL reconstruction:

1. In ACL repair, recovery is faster.
2. It allows the surgeon to simultaneously perform additional procedures, such as meniscus or cartilage restoration.
3. It is less expensive than ACL reconstruction.

However, ACL repair does come with certain risks. For instance, the repaired ligament can fail again later. However, fibre tape internal brace surgical procedures drastically reduce the failure rate.

Also, the procedure can cause damage to surrounding tissues. Finally, it is not recommended for patients who have had previous knee surgeries.

ACL Repair vs. Reconstruction Comparison Chart

ACL Surgery FAQs: Repair, Recovery Time, and Returning to Sports