Treatment depends on knee stability, associated injuries and sporting goals. For athletes requiring reconstruction, Dr. Haber generally favors patellar or quadriceps tendon autograft.
AT A GLANCE
Understanding an ACL injury
The anterior cruciate ligament (ACL) helps control knee stability during cutting, pivoting, deceleration and landing. Injuries commonly occur during soccer, basketball, football and skiing, sometimes without direct contact. A sudden pop, swelling, instability or difficulty trusting the knee may prompt evaluation.
Symptoms and MRI findings do not always tell the entire story. Dr. Haber reviews your physical examination, X-rays and MRI when appropriate, and looks for related problems such as meniscus tears, cartilage injury or damage to other ligaments.
When is ACL surgery recommended?
Not every ACL injury requires surgery. Structured rehabilitation and activity modification may be reasonable for selected patients who do not experience instability and whose preferred activities place lower demands on the knee. Reconstruction may be recommended when giving-way episodes persist, the goal is a return to cutting or pivoting sports, or associated injuries make surgical treatment more appropriate.
Age alone does not dictate ACL treatment; knee stability, activity demands and personal priorities do.
ACL reconstruction and graft selection
Reconstruction replaces the torn ACL with a tendon graft, usually arthroscopically. Graft choice is central to the plan.
For athletes who require ACL surgery, Dr. Haber generally favors reconstruction with a patellar tendon or quadriceps tendon autograft — using the patient’s own tissue. He performs BEAR ACL repair in specific, carefully selected situations when the injury pattern and native ligament tissue make repair a reasonable option. The recommendation is always individualized to the patient’s sport, anatomy, associated injuries, and goals.
- Patellar tendon autograft: uses tissue from your own patellar tendon; may be favored for selected high-demand athletes, while kneeling discomfort and anterior knee pain are considerations.
- Quadriceps tendon autograft: uses tissue from the quadriceps tendon; can provide a substantial graft with its own recovery and donor-site considerations.
- Hamstring tendon autograft: uses one or more hamstring tendons; graft characteristics and the effect on hamstring strength are part of the discussion.
- Allograft: donor tendon tissue may be reasonable in selected situations; for younger, highly active patients, studies have shown higher failure rates than with autograft tissue.
Graft choice reflects sport, age, knee anatomy, associated injuries and patient priorities. Each option has trade-offs.
REPAIR OPTION USED IN SELECTED SITUATIONS
BEAR ACL repair: restoring the native ligament
Bridge-Enhanced ACL Restoration (BEAR) is an implant-assisted technique that aims to help the patient's torn ACL heal rather than replacing the ligament with a tendon graft. During the procedure, a resorbable scaffold and the patient's own blood are used to help bridge the torn ligament ends.
BEAR is considered only when the native ACL has suitable remaining tissue and the tear pattern is favorable. MRI findings, associated injuries and athletic demands guide selection. For most athletes requiring surgery, patellar or quadriceps tendon autograft reconstruction remains preferred.
Early comparative clinical studies have reported encouraging knee function after BEAR in appropriately selected patients, but no operation eliminates the risk of re-tear, stiffness or further surgery. Rehabilitation after BEAR is structured and may differ from standard ACL reconstruction; it should not be assumed to offer an automatically faster return to sport.
Learn about BEAR from the implant manufacturer ↗ · Read a 2025 peer-reviewed evidence review ↗
Meniscus preservation and other knee injuries
The ACL rarely exists in isolation. Meniscus tears, including root tears, cartilage injuries or other ligament damage may change surgical timing, rehabilitation restrictions and long-term joint goals. Preserving repairable meniscus tissue is often an important consideration. Learn about meniscus repair and preservation.
What happens before and during ACL surgery?
When an operation is planned, attention often turns first to reducing swelling, regaining knee extension and restoring quadriceps control. This “prehabilitation” can make the early recovery process more manageable. During reconstruction, Dr. Haber tailors graft preparation, tunnel positioning, fixation and treatment of related injuries to the knee’s anatomy and surgical findings.
Arthroscopic reconstruction uses small incisions, but full rehabilitation remains essential.
Rehabilitation and return to sport
- First 6 weeks: protect the knee. All of Dr. Haber’s ACL surgery patients wear a hinged knee brace for the first 6 weeks. Crutches and weight-bearing progression commonly range from 2–6 weeks, depending especially on meniscus repair, cartilage treatment or other ligament procedures performed at the same time.
- Early priorities: motion and quadriceps control. Work toward full knee straightening (extension) and bending (flexion) within your procedure-specific limits. Restore activation and control of the quadriceps—the muscles on the front of the thigh—then normalize your walking pattern when ready.
- Around 4–6 months: begin jogging when cleared. Progress depends on healing, strength, knee control and any additional procedures.
- Around 6 months: introduce jumping drills. Plyometrics—controlled jumping and landing exercises—are followed by progressive work on strength, muscular power and agility as criteria are met.
- Usually no sooner than 10–12 months: return to sport. Timing depends on the sport, any additional procedures and meeting objective return-to-sport testing criteria with physical therapy. Reaching a date alone does not mean the knee is ready.
Rebuilding quadriceps strength
Dr. Haber supports advanced rehabilitation techniques, including supervised blood flow restriction (BFR) training when appropriate, to help regain quadriceps activation and control early in recovery. Your therapist determines whether and how to include it in your prescribed program.
Risks and realistic expectations
Potential risks include infection, blood clots, stiffness, persistent discomfort or instability, graft failure or reinjury, donor-site symptoms, and a need for additional surgery. ACL reconstruction can restore stability for many patients, but it does not eliminate all future injury or arthritis risk. Discuss expected benefits, rehabilitation demands and alternatives in the context of your individual situation.
Care informed by athletes and research
As a physician for the U.S. Ski & Snowboard Teams and a team physician for University of Denver Athletics, Dr. Haber brings experience with high-level sport to everyday patient care. Collegiate and professional athletes, high school competitors, weekend skiers and active adults receive the same attention to a careful diagnosis, shared decisions and an individualized plan.
His peer-reviewed research has explored ACL reconstruction techniques, graft measurements, outcomes and return to professional soccer. Explore Dr. Haber's publications.
A patient story
Panorama features Monica’s ACL Reconstruction and Meniscus Root Repair — Dr. Haber ↗. Patient stories can help illustrate the treatment journey, although each recovery is different and outcomes cannot be guaranteed.
A clear plan begins with a careful evaluation.
Learn whether physical therapy, ACL reconstruction, BEAR ACL repair, meniscus treatment or another approach best fits your knee and your priorities.
Frequently asked questions
Does every ACL tear need surgery?
Not always. Rehabilitation may be reasonable when the knee is stable and activity demands are lower. Surgery is considered for instability, pivoting sports or associated injury.
Which ACL graft is best for me?
Each graft has trade-offs. For most athletes, Dr. Haber favors patellar or quadriceps tendon autograft; allografts require caution in younger, high-demand patients.
Is BEAR ACL repair an alternative to reconstruction?
Only for select tears with suitable native ACL tissue. Most athletes requiring surgery receive patellar or quadriceps tendon autograft reconstruction.
How soon can I return to skiing, soccer or basketball?
Return to skiing, soccer, basketball and other pivoting sports is generally no sooner than 10–12 months. Clearance depends on healing, any additional repairs and meeting objective strength and functional testing goals with physical therapy.
Can a meniscus tear be treated during ACL reconstruction?
Often, yes. The treatment plan depends on the location, tissue quality and repairability of the tear. Preserving viable meniscus tissue when possible is an important part of joint-preserving care.
Evidence and additional reading
Patient education: American Academy of Orthopaedic Surgeons — Management of ACL Injuries ↗. This general guidance complements, but does not replace, an individualized clinical consultation.