ACL Tears & Reconstruction
What Is an ACL Tear?
The ACL (anterior cruciate ligament) is one of the primary ligaments stabilizing your knee, controlling the forward motion and rotation of your shinbone relative to your thighbone. A tear typically happens during a sudden stop, pivot, or awkward landing, common in skiing, soccer, basketball, and similar sports, and often comes with an audible pop and immediate swelling. Because the ACL has limited ability to heal on its own, a full or partial tear is most often treated with reconstruction, rebuilding the ligament using a graft. In select cases, based on the quality of your torn tissue, repair with the BEAR Implant may be an option instead, preserving and helping regenerate your own native ACL rather than replacing it.
This is you if:
- You felt or heard a pop in your knee during a pivot, cut, fall, or awkward landing, whether skiing, playing sports, or otherwise, followed by swelling
- Your knee feels unstable or like it's going to “give out,” especially during pivoting or cutting motions
- You've already been told you have an ACL tear and want an honest read on your real options
- You're an athlete or active person who wants to return to skiing, pivoting sports, or cutting sports
- You want to understand which treatment, repair or reconstruction, and which graft if needed, is actually right for you
Symptoms
- A pop felt or heard at the moment of injury
- Rapid swelling within hours of the injury
- A feeling of instability or “giving way,” especially with pivoting or cutting
- Pain and difficulty putting full weight on the knee
- Loss of full range of motion
Causes & Risk Factors
- Sudden pivoting or cutting movements — common in soccer, basketball, and football
- Skiing falls or awkward landings — a leading cause of ACL tears in Colorado, often from a twisting fall or catching an edge
- Awkward landing from a jump
- Direct contact or collision to the knee
- Sudden deceleration or change of direction
- Previous ACL injury — increases risk of a future tear, in either knee
Non-surgical first.
Some lower-demand patients, particularly those who don't participate in pivoting sports or skiing, can manage a torn ACL with physical therapy, bracing, and activity modification alone. For active patients and anyone who wants to return to skiing, cutting, or pivoting sports, surgical treatment is typically recommended, since the ACL has very limited ability to heal on its own. Left unaddressed, an unstable knee is at greater risk for further injury, including damage to your meniscus or cartilage from repeated episodes of giving way, which can lead to earlier arthritis in the joint over time.
Repair — BEAR Implant.
In select cases, based on the quality of your torn ACL tissue, repair with the BEAR Implant (Bridge-Enhanced ACL Restoration) may be the right option. This is a repair, not a replacement: Dr. Thon repairs your own torn ACL and augments it using the BEAR Implant, a collagen-based scaffold, combined with your own blood, to form a protective bridge between the torn ends of your native ligament. That bridge supports your body's own healing process. The implant resorbs within about 8 weeks and becomes a part of you, leaving your own regenerated, repaired ligament behind.[1] Not every tear qualifies, an intact attachment point on the shin bone is required, but for the right candidate, preserving and repairing your native ACL is a meaningful advantage over replacing it entirely.
Pros: Preserves your native ACL rather than harvesting a graft from elsewhere in your body or a donor; no graft-site pain or weakness; implant fully resorbs and becomes a part of you, leaving your own tissue behind.
Cons: Not every patient and tear qualifies, requires adequate tissue quality; newer technique with a shorter track record than established graft reconstruction. Reconstruction is the backup option if tissue quality isn't a fit for repair.
Reconstruction — choosing the right graft.
When your tear isn't a candidate for repair, or reconstruction is otherwise the better path, the choice of graft depends on your age, activity level, and goals:
- Bone-Patellar Tendon-Bone (BTB) Graft — Uses a section of your own patellar tendon.
Pros: The longest track record of any graft (30+ years); strong durability; lower risk of re-tear in younger, high-demand athletes, including skiers and cutting-sport athletes.
Cons: Additional incision at the graft site; historically associated with more kneeling pain and a small risk of patellar tendon or kneecap issues.
- Quadriceps Tendon Graft — Uses a strip of your own quadriceps tendon.
Pros: Strong, all-soft-tissue graft; less tissue removed than BTB; smaller incisions; typically less postoperative pain.
Cons: Newer track record than BTB; some early quadriceps weakness during recovery.
- Allograft — Uses donor tissue.
Pros: No additional incision or graft-site pain; shorter initial recovery in some patients.
Cons: Higher re-tear risk in younger, high-demand athletes; relies on donor tissue processing and availability.
(Hamstring tendon graft is also a well-established option elsewhere, but it isn't one Dr. Thon uses in his practice.)
Dr. Thon will walk you through whether repair or reconstruction is right for you, and if reconstruction, which graft fits your body, your sport, and your goals, and explain honestly why.
Recovery & What to Expect
- Timing of surgery: ACL reconstruction is generally best performed 4-6 weeks after your injury, once swelling has gone down and you've regained your range of motion, to reduce the risk of stiffness afterward. Many patients are sent to “pre-hab” physical therapy before surgery to help prepare the knee and improve results.
- Brace: A minimum of 6 weeks, worn at all times except during physical therapy, showering, changing, and while awake at complete rest.
- Physical therapy: Begins within 1-2 weeks after surgery, at least once weekly for the first 6-12 weeks.
- Follow-up visits: You'll be seen 6 times after surgery, spaced with gradually increasing time between visits over the following year.
- Overall timeline: Recovery is gradual — most patients regain normal gait and full range of motion around 3 months, notice a significant difference by 6 months, and return to full sports participation around 9-12 months.
Every recovery is different, and depends on the extent of your tear and any other injuries addressed at the same time. Dr. Thon will walk you through your personal timeline in detail.
Why Choose Orchard Orthopedics for This
You'll always see Dr. Thon personally for your ACL evaluation and surgery, not a resident or rotating provider. Whether your tear came from skiing, a field or court sport, or something else entirely, the choice between repair and reconstruction, and the choice of graft if reconstruction is the right path, is one of the most consequential decisions in your care. You'll get an honest, personalized recommendation based on your tissue, your body, and your goals, not a one-size-fits-all default, paired with the direct access and unhurried follow-up care Orchard Orthopedics is built around.
Frequently Asked Questions
Understanding Your Injury
The ACL has very limited ability to heal on its own. Some lower-demand patients who don't play pivoting sports or ski can manage without surgery, but most active patients need surgical treatment to safely return to cutting, pivoting, or skiing.
An unstable knee is at higher risk for further injury, including damage to your meniscus or cartilage from repeated episodes of instability, which can lead to earlier arthritis over time. An evaluation gives you an honest picture of your specific risk.
Operating too soon, before swelling has resolved and motion has returned, increases the risk of stiffness afterward. Waiting 4-6 weeks, often combined with “pre-hab” physical therapy, typically leads to a better outcome, fewer complications, and more function.
Occasionally, other structures like the meniscus or cartilage are more damaged than imaging suggested. If that happens, Dr. Thon will address what's actually there and explain exactly what changed and why, before, during, and after your procedure.
Deciding on Treatment
It depends on the quality of your torn tissue, not how long ago you were injured. If your tear is a good fit, repair with the BEAR Implant preserves your own native ACL. If not, reconstruction with a graft is the reliable, well-established path forward. Dr. Thon will tell you honestly which one fits your case.
It depends on your age, activity level, goals, and anatomy. Dr. Thon will walk you through the tradeoffs of each option, bone-patellar tendon-bone, quadriceps tendon, or allograft, and give you an honest recommendation for your specific situation.
Yes, especially before surgery. A second opinion isn't a lack of trust in your first doctor. It's a normal, expected step, and many patients return to their original surgeon with more confidence in the plan either way.
I have no insurance panel dictating my decisions and no quota to hit. I'll tell you honestly when non-surgical management is realistic for your lifestyle, and when surgery is the better path.
That's a completely normal reaction. Your visit is the place to ask every question you have, including ones about anesthesia, risk, and what the day of surgery actually looks like, until you feel genuinely informed, not just signed up.
Age alone doesn't rule out surgery. What matters more is your activity level, your goals, and how much the instability is limiting your life. Existing arthritis in the knee is also a factor, since it can change whether ACL surgery is likely to help or whether treatment should focus elsewhere. Dr. Thon will factor that into an honest recommendation for your specific knee.
Access & the Orchard Model
No. You can call and schedule directly, no referral or prior authorization required.
You'll always start with Dr. Thon on your initial visit for your ACL evaluation and surgery. He remains closely involved in your care throughout.
Surgery & Recovery Logistics
Most patients can be seen same-day or next-day. Call the office and we'll get you scheduled quickly.
Surgery typically takes about 1.5 to 2 hours. It's an outpatient procedure, so you'll go home the same day.
A minimum of 6 weeks, worn at all times except during physical therapy, showering, changing, and while awake at complete rest. The exact duration depends on your specific repair or reconstruction.
Most people can drive again 2-6 weeks after surgery, once fully off narcotic pain medication. Return to work depends on your job — desk jobs often resume in 1-2 weeks, while jobs requiring heavy lifting may take 8-12 weeks or longer.
Most patients regain normal gait and motion around 3 months, feel a significant difference by 6 months, and return to full sports or skiing around 9-12 months.
Whether repair or reconstruction is right for your ACL, get an honest answer and a plan built specifically for you.
Already have a diagnosis or imaging from somewhere else? [ Get a second opinion ]
References
[1] BEAR Implant — Bridge-Enhanced ACL Restoration, Miach Orthopaedics (miachortho.com/patients-and-families/bear-implant).