What Is an ACL Tear and Do You Always Need Surgery?
The anterior cruciate ligament (ACL) is one of the four main stabilising ligaments of the knee, preventing the tibia from sliding forward and providing rotational stability. ACL tears are among the most common sports injuries, affecting football players, skiers, basketball players, and anyone who experiences a sudden pivoting or cutting mechanism.
Not every ACL tear requires reconstruction. Active patients returning to cutting and pivoting sports virtually always need surgery. However, older or less active patients with isolated tears and no meniscal damage may manage well with physiotherapy alone. Our sports medicine team assesses your activity level, age, associated injuries, and knee instability before recommending operative or non-operative management.
Returning to sport before 9 months significantly increases re-tear risk — time is a minimum, not a target.
Graft Options for ACL Reconstruction
The main graft options are:
- Hamstring tendon autograft (semitendinosus ± gracilis): Most common choice. Minimal donor-site morbidity, good long-term outcomes, smaller incision. Preferred in most athletes.
- Bone-patellar tendon-bone (BPTB) autograft: Gold standard for high-demand athletes. Bone-to-bone healing is faster and more reliable.
- Quadriceps tendon autograft: Growing in popularity. Larger cross-sectional area, low donor-site morbidity. Increasingly preferred for revision ACL surgery.
- Allograft (donor tissue): Avoids donor-site morbidity but has longer integration time. Generally not preferred for young, high-demand athletes.
The Surgical Procedure
ACL reconstruction at Central Hospital Istanbul is performed arthroscopically — through two or three small portals, using a camera and instruments rather than open surgery. The procedure takes 45–90 minutes under spinal or general anaesthesia and is typically done as a day case or with a single overnight stay.
Associated injuries are addressed simultaneously. A torn medial meniscus may be repaired (preferred over resection); cartilage defects may be treated with microfracture or chondral grafting depending on size and depth.
Cost of ACL Reconstruction in Istanbul
- ACL reconstruction (autograft, arthroscopic): $6,000–$9,000 all-inclusive in Istanbul
- UK private pay: £8,000–£14,000
- US without insurance: $20,000–$50,000
- ACL + meniscal repair combination: $8,500–$12,000 in Istanbul
- Revision ACL reconstruction: $10,000–$15,000 depending on graft choice and complexity
ACL Rehabilitation Protocol: Phase by Phase
Rehabilitation is as important as the surgery itself. A well-structured, criterion-based protocol is essential for safe return to sport and reducing re-tear risk.
- Phase 1 (0–2 weeks): Reduce swelling, restore full extension, achieve quad activation. Crutches until full weight-bearing is comfortable.
- Phase 2 (2–6 weeks): Restore full range of motion, begin closed-chain exercises (mini-squats, leg press), normalise gait.
- Phase 3 (6–12 weeks): Progressive strengthening, proprioceptive training, begin jogging when cleared by criteria (symmetrical strength, no swelling).
- Phase 4 (3–5 months): Running programme, agility drills, sport-specific movement patterns.
- Phase 5 (6–9 months): Return to full training — only when objective criteria are met (limb symmetry index >90%, hop tests, psychological readiness).
Research consistently shows that patients who return to sport before 9 months have significantly higher re-tear rates. At Central Hospital, we take a time-plus-criteria approach — time is a minimum threshold, not a target.
Remote Rehabilitation for International Patients
Most of the ACL rehabilitation programme can be performed at your local physiotherapy clinic at home. Our team provides a detailed written protocol, video library, and regular telehealth check-ins. We partner with physiotherapists in many countries to ensure continuity of care.
Questions to Ask Before ACL Surgery in Istanbul
- Which graft do you recommend for my age, activity level, and associated injuries?
- Are any associated injuries (meniscus, cartilage) being addressed at the same time?
- What is the surgeon's personal re-tear rate at 2 years?
- How is the rehabilitation protocol structured, and can it be continued in my home country?
- Will I receive a written rehabilitation protocol before I leave hospital?