What is ACL repair, and how is it different from ACL reconstruction?

Two different ideas

In a reconstruction, the torn ACL is removed and a graft, usually from the hamstring, patellar or quadriceps tendon, is passed through tunnels in the bones. The graft slowly remodels into a ligament-like structure over many months.

In a repair, the surgeon keeps your own ligament. The torn end is stitched and fixed back to its attachment on the thigh bone, often with a small anchor. Many techniques add a strong suture tape alongside the ligament to protect it while it heals.

Why the tear pattern matters

The ACL has a poor blood supply in its middle, so a tear through the middle of the ligament rarely heals even when stitched. Tears that peel off the femoral attachment, with a long healthy stump, behave differently and can heal back to bone.

That is why repair is a narrow option rather than a replacement for reconstruction. The MRI gives a strong hint, but the final decision is usually made during arthroscopy, when the tissue can be seen and tested directly.

Possible advantages and trade-offs

• No graft is harvested, so there is no donor-site pain from the tendon
• Your own ligament keeps its nerve endings, which may help the knee's sense of position
• Bone tunnels are small, so a later reconstruction, if needed, is usually straightforward
• Re-tear rates in some studies are higher than after reconstruction, especially in young athletes in pivoting sports

How the choice is made in Doha

At Aman Hospital, Dr. Gelber reviews how and when the injury happened, examines the knee and studies the MRI. If repair looks possible, you will usually be consented for both procedures, so the right one can be done once the ligament is seen. Your sport, age and goals are part of that conversation from the start.