ACL Reconstruction at the Orthopedic Surgeon

How does the surgery work?

ACL reconstruction is done with a method called arthroscopy. The surgeon makes a few small cuts around your knee, no bigger than a buttonhole. A tiny camera goes in one cut, and thin tools go in the others. The picture shows up on a screen, so the surgeon never has to open the whole joint.

The biggest choice you and your surgeon make is the graft.

• Patellar tendon (your own): A strip from the tendon below your kneecap, with a small block of bone on each end. Very strong and often chosen for athletes, but the donor site below the kneecap can stay sore during kneeling for a while.
• Hamstring tendon (your own): Tendons from the back of your thigh. Less front-of-knee pain, a common all-around choice.
• Quadriceps tendon (your own): From above the kneecap. Strong and increasingly popular.
• Donor graft (allograft): Tissue from a tissue bank. No second wound on you, but a higher re-tear rate in young, active patients.

The surgeon drills a small tunnel in your shin bone and another in your thigh bone, then passes the graft through and anchors it with screws or buttons. The new ligament sits right where the old one did. The whole operation usually takes one to two hours.

How much does ACL reconstruction cost?

ACL reconstruction is a medically necessary procedure, so insurance almost always covers it. What you actually pay depends on your plan, your deductible, and whether your surgeon and surgery center are in network. The sticker price before insurance is high because you are paying a surgeon, an anesthesiologist, the facility, the graft, and the implants all at once.

The biggest money mistake is skipping the price talk. Call your surgeon's billing office and your insurer before the date is set. Ask for the total estimate with every part included, not just the surgeon's fee.

• Use an in-network surgeon and an in-network surgery center. An out-of-network facility can double your bill even if the surgeon is covered.
• Ask about the surgery center versus the hospital. A free-standing surgery center is often far cheaper than a hospital operating room for the same procedure.
• Get the graft type in the estimate. A donor graft adds a tissue-bank fee that your own tissue does not.
• If you are paying cash, ask for the self-pay or bundled price. Many centers cut the cash price well below the list price if you ask.

Physical therapy is a separate cost that runs for months. Budget for it from the start, because it is not optional.

Ranges are typical US estimates and cover the surgeon, anesthesia, facility, graft, and implants. They do not include months of physical therapy, which is billed separately. Always ask for a written all-in estimate before your date.

What is recovery like, week by week?

You will go home the same day in most cases. Plan for a ride and someone to help you for the first few days.

• Week 1: Pain and swelling peak. You use crutches and often a brace. The first job is simply to straighten the knee fully and get the swelling down.
• Weeks 2 to 6: You wean off crutches as your leg gets stronger. Physical therapy focuses on full bending and full straightening, and on waking up your thigh muscle, which shuts down after surgery.
• Months 2 to 4: You walk normally, ride a stationary bike, and start light strength work. The graft is healing but is actually at its weakest around this time, so follow the plan and do not improvise.
• Months 4 to 9: You jog, then run, then add agility drills once your strength and balance pass certain tests.
• Months 9 to 12: Return to cutting and pivoting sports, but only after your surgeon and therapist clear you with strength and hop tests.

A knee brace is common early on for support and after return to sport for some people. Your surgeon decides if and when you need one. Recovery is measured in months, not weeks, and rushing it is the main reason grafts fail.

What exercise and rehab do you need?

The surgery rebuilds the ligament, but rehab is what makes the knee work again. People who skip physical therapy end up with a stiff, weak knee even when the graft is perfect. Think of the operation and the rehab as one treatment, not two.

Your therapist guides you through stages. Early on, the goal is full bending and straightening, and a thigh muscle that fires. If you lose full straightening in the first weeks, it can be hard to get back, so this comes first.

• Range of motion: Gentle bending and straightening, heel slides, and getting the kneecap moving.
• Strength: Quad sets early, then leg presses, squats, step-ups, and hamstring work as you progress.
• Balance and control: Single-leg standing and landing drills that retrain your knee to react.
• Return-to-sport testing: Hop tests and strength comparisons between legs before you are cleared to cut and pivot.

Do the home exercises every day, not just at your visits. The people who recover fastest are the ones who treat the daily plan as the job. If you feel sharp pain or notice new swelling, tell your therapist before pushing through it.

Why you should not tough it out or rush back

There is no safe way to fix a torn ACL at home, and toughing it out has real costs. A knee that keeps giving way damages the cartilage and meniscus a little more each time it buckles. Over years, that wear can turn into early arthritis. Choosing surgery or not is a real decision, but ignoring an unstable knee is not a free option.

The other big danger is rushing the comeback. The new graft feels strong long before it actually is. Around two to four months it is at its weakest while your body remodels it. Athletes who return to sport too soon, often before nine months, have a much higher chance of a second tear, sometimes in the other knee.

• Do not skip the workup. Many ACL tears come with a meniscus or cartilage injury. Without imaging and a proper exam, those get missed and keep hurting after surgery.
• Do not chase someone else's timeline. Your clearance comes from strength and hop tests, not from how a teammate healed.
• Watch for warning signs: a fever, a calf that is hot or swollen, drainage from a wound, or a knee that locks or gives way. Call your surgeon for any of these.

Protect the knee now so you are not back in the operating room next season.

CPT and ICD-10 codes for insurance

Your insurance paperwork and bills will show codes, and knowing them helps you check that you were billed correctly.

• CPT 29888 is the procedure code for arthroscopically aided ACL reconstruction. It appears on the surgical claim for most ACL surgeries.
• ICD-10 S83.51- codes describe the injury itself, a sprain or tear of the anterior cruciate ligament of the knee. The exact code adds a digit for the left or right knee and a letter for the visit type.
• An aftercare or follow-up code may appear on later visits and on physical therapy claims.

When you read your explanation of benefits, match the procedure code on the bill to what your surgeon told you. If you see a code for a procedure you did not have, call the billing office. Mistakes happen, and they are easier to fix early.

If your insurer denies part of the claim, ask your surgeon's office to send a letter of medical necessity. A torn ACL with an unstable knee is a standard reason for approval, and a clear note from your surgeon usually settles it. Keep copies of every estimate and bill in one place.

How to find an orthopedic surgeon near you

ACL reconstruction is done by orthopedic surgeons, and within that field, many focus on sports medicine and the knee. You want someone who does this operation often, because volume and experience matter here.

When you meet a surgeon, ask plain questions:

• How many ACL reconstructions do you do each year? Higher numbers usually mean more practiced hands.
• Which graft do you recommend for me, and why? The answer should fit your age, sport, and goals, not be the same for everyone.
• Who runs my rehab, and how do you decide when I can return to sport? You want a clear, test-based plan.
• Is the surgery center in my insurance network? This protects you from a surprise facility bill.

It is fair to get a second opinion, especially before a big operation. A good surgeon will not be bothered by it.

You can use OurHealthNetwork to find orthopedic surgeons near you, compare their backgrounds, and check which insurance plans they accept. Start with surgeons close to home, since you will see them many times during recovery, then narrow by experience and the plans you carry.

Frequently Asked Questions

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Medical disclaimer: This content is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about a medical condition. If you have a medical emergency, call 911. Our editorial standards