Questions to Ask Before ACL Surgery
For anyone with a torn ACL, and for the parent of a teenage athlete with one, getting ready for the consultation with an orthopedic or sports medicine surgeon. The list follows the order the decision usually takes: surgery or rehab alone, timing and prehab, the graft and anything else repaired in the knee, the surgeon's own numbers, the operation and the first weeks, and the long rehab back to work, school, driving and sport. Under each question is what a careful answer about your own knee tends to include and what a vague one leaves out; the surgeon's reply is the medical advice, not this page.
The questions
Each question, and why to ask it
Surgery or rehab
Is my ACL fully torn or partly torn, and what else did the MRI show in the knee?
Why ask it
Have the ligament, each meniscus and the cartilage pointed out on the images one at a time. What sits alongside the tear often shapes the advice more than the tear does, so write down every finding and not only the headline.
Do I need surgery, or could rehab alone get me back to what I want to do?
Why ask it
A good answer starts with your sport, your job and how the knee behaves now. If you hear that everyone with this tear needs an operation, or that nobody does, ask what about your knee in particular leads there.
If I have the reconstruction, what is it meant to fix, and what will it not fix?
Why ask it
Buckling, pain and swelling are separate complaints, and a new ligament may not answer all three. Have the surgeon take them one at a time for your knee, so you know which to expect gone and which may stay.
If I try rehab first and the knee keeps giving way, what have I lost by waiting?
Why ask it
The thing to pin down is whether each buckle puts the meniscus or cartilage in your knee at risk, or whether a delay would cost you only time. Then settle how many weeks make a fair trial of rehab and what would end it early.
What does this knee look like in ten or twenty years with surgery, and without it?
Why ask it
An honest answer admits how much is uncertain, arthritis included. Be wary of a promise that an operation protects the knee for life, and ask what besides surgery is in your own hands.
Which activities would I have to change or give up if I decide against surgery?
Why ask it
Name yours out loud: soccer, skiing, a job on ladders, chasing a toddler. Straight-line exercise such as cycling tends to get a different answer from jumping and sudden turns, so go through your list item by item.
My child is still growing. How does that change the decision and the operation itself?
Why ask it
The concern is the growth plates near the knee. Find out how the surgeon judges how much growing is left, whether the technique changes for a growing knee, and whether a pediatric sports surgeon should be the one to do it.
Could a brace get me through the rest of the season, or one event that matters, before I decide?
Why ask it
A breezy yes with no mention of what happens if the knee gives way mid-game is the worrying answer. Ask what a brace can and cannot do for an ACL-deficient knee, and what one more episode might damage.
Timing
How soon should the operation happen, and what are you waiting for the knee to do first?
Why ask it
Many surgeons want the swelling down, the knee straightening fully and the thigh muscle working before they operate. Find out which of those your knee has managed today and who checks the rest before the date is fixed.
What prehab should I be doing before surgery, and who sets the program?
Why ask it
Get it specific: which exercises, how many times a week, with a physical therapist or from a printed sheet. Ask what you should be able to do by the day of surgery, so the weeks before it have a target.
Is anything in my knee time sensitive, such as a meniscus tear that catches or locks?
Why ask it
A knee that gets stuck or will not straighten is a different conversation from one that only feels unstable. If the surgeon says it can wait, ask which new symptom should have you calling before the next appointment.
What should I stop doing between now and the operation so I do not make the knee worse?
Why ask it
'Take it easy' is too vague to follow. Go through the gym, running, gym class, work shifts and anything with a ball, and get a yes or a no on each.
I would like to plan this around a season, exams or a busy stretch at work. Is that reasonable for this knee?
Why ask it
Count backward from the date you most want to be back, then find out whether the knee can safely wait that long and what you would have to avoid in the meantime. A surgeon who only discusses their own next opening has not answered.
Do I need tests or a medical clearance first, and which of my medicines or supplements should I pause?
Why ask it
Write out everything you take, including the pill, acne medication, inhalers and anything from a supplement store, which teenagers and young adults tend to leave off. For each one the answer you need is carry on, or stop this many days ahead, plus who to call if you forget.
Graft and repairs
Which graft do you recommend for me, and why that one over the others?
Why ask it
Listen for your age, your sport and how you use the knee, such as a job that has you kneeling. If the answer is 'it is the one I always use', ask what would make them choose differently.
What are the trade-offs between a patellar tendon, a hamstring and a quadriceps tendon graft?
Why ask it
Each borrows tissue from a different place, so each leaves a different complaint behind. Ask about pain at the front of the knee, kneeling, and lasting weakness in the muscle that gave up the tendon, and make sure you hear the downside of the one being recommended.
When would you use donor tissue, and is it a reasonable choice at my age and activity level?
Why ask it
Donor tissue spares your own tendons, and surgeons often talk about it differently for a teenage athlete than for an adult with a desk job. Ask what their own experience with re-tears has been in patients like you, and how the tissue is screened and prepared.
Which graft do you use most often, and how many of the other kinds do you do in a year?
Why ask it
A surgeon is usually at their best with the one they harvest every week. If the graft you are leaning toward is one they rarely use, better to learn that now and decide whether to change the graft or the surgeon.
Where will the incisions be, and should I expect numbness or trouble kneeling afterward?
Why ask it
Ask them to draw the cuts on your knee with a finger. This matters most if you kneel for work, prayer, gardening or wrestling. A numb patch beside the scar comes up often, so ask how common it is in their patients and whether it fades.
If you find meniscus or cartilage damage, what will you do about it, and how does each option change my recovery?
Why ask it
A meniscus that is repaired and one that is trimmed can mean very different first weeks on crutches, in a brace and with limits on bending. Get both versions of the plan now, because you will wake up to one of them without being consulted.
Do you plan to add anything to the graft itself, such as an extra reinforcement on the outside of the knee?
Why ask it
Some surgeons add one for patients they consider at higher risk of tearing the graft, or when a second ligament is damaged. Find out whether you are in that group and why, write down the name of the procedure, and ask what it means for scars, pain and rehab.
How long does the new graft take to become as strong as it is going to get?
Why ask it
This is the reason a knee can feel ready months before anyone will clear it. Have the surgeon explain what the graft is doing over the first year, and write it down to reread around month four, when the knee feels fine and patience runs out.
Your surgeon
How many ACL reconstructions do you do in a year, and how many in patients my age?
Why ask it
Someone who does these every week answers without having to think. Parents of a young teenager should ask the second half on its own, since operating on a growing knee is a narrower skill.
Will you do the whole operation yourself, and who else will be working on my knee?
Why ask it
At a teaching hospital a resident or fellow may do part of the case, and elsewhere an assistant may prepare the graft. It works differently from one hospital to the next, so find out who does which step and whether the surgeon is in the room from start to finish.
What is your own re-tear rate, and how do you keep track of it?
Why ask it
The strongest answer is a number plus how they know it: follow-up visits, a registry, a database. 'Very low' with no way of knowing is weaker. If they do not track it, ask what range they would expect for someone your age in your sport.
How many of your patients get back to the sport and the level they played at before?
Why ask it
Split it in three: back to any sport, back to the same level, and still playing two seasons later. Those are different figures, and the last one is the one to plan around.
What complications do you see after ACL reconstruction, and which one worries you most for my knee?
Why ask it
A knee that will not fully straighten, an infection, a clot in the leg and a graft that fails are the ones most patients have read about. Have the surgeon rank them by what turns up in their own practice, and say what is done in the first weeks to head off the top one.
Will the surgery be at a hospital or an outpatient surgery center, and why there?
Why ask it
Ask how often ACL cases are done at that site and what happens if you need to stay the night. Where insurance is involved, the choice of facility can change the bill, so ask the office how that works for your plan.
What will this cost me in total, including the brace, any cold therapy machine and months of physical therapy?
Why ask it
Where patients pay, the surgeon, the facility, the anesthesia, donor tissue, the brace and the therapy can each arrive as a separate bill, and what is covered depends on your country and your plan. Get a written estimate from the office, then check whether your coverage caps therapy visits, because ACL rehab runs for months.
Surgery and first weeks
How long does the operation take, and what would make it run longer?
Why ask it
The honest answer is a range, and a meniscus repair or other work found inside the knee is what usually stretches it. Give whoever is in the waiting room the longer figure, and ask whether the surgeon comes out to talk to them afterward and whether you get the pictures from the scope.
What kind of anesthesia will I have, and will I get a nerve block?
Why ask it
Ask how long a block lasts, how weak the leg will be while it is working, and how to move safely until it wears off. Mention any bad reaction you or a close relative has had to anesthesia, and ask when you get to speak with the person giving it.
What is the plan for pain in the first week, and how do I come off the stronger medicine?
Why ask it
Have the schedule written out: what you take by the clock, what is for breakthrough pain, and the day the strong tablets stop. For a teenager, ask who should hold the bottle. A prescription with no end date is the thing to question.
Will I go home the same day, and who needs to be with me that first night?
Why ask it
Line up the driver and the overnight helper before you leave the consultation. Ask how to get into a car with a leg that will not bend much, and whether sleeping downstairs for a few nights is wise if your bedroom is up a flight.
Will I be in a brace or on crutches afterward, and for how long in each case?
Why ask it
The answer often hangs on what is done to the meniscus, so get the short version and the long version. Have the therapist fit the crutches and teach you stairs at a prehab visit, so your first attempt is not on the way home.
How do I keep the swelling down and get the knee straight in the first days?
Why ask it
Ask for the routine in numbers: how long to ice, how often to elevate, how many times a day to prop the heel. Find out by when the leg should lie fully flat, and whether an ice machine is worth renting or a bag of frozen peas does the job.
In the first two weeks, what should send me to the phone, and what should send me to an emergency room?
Why ask it
Have the office write both lists down, with the after-hours number at the top. Calf pain, trouble breathing, fever and an incision that drains tend to be on them, so pin down the threshold for each. Parents: put it on the fridge.
Rehab and return
When does physical therapy start, and will you send the therapist your protocol?
Why ask it
Ask whether they can name therapists who see ACL patients every week. Book the first visit before the operation, since good clinics fill up, and take a copy of the protocol with you in case it never arrives.
What does rehab look like month by month, and what should I be able to do at each stage?
Why ask it
Push for milestones, not only dates: walking without a limp, full bend, jogging, jumping, cutting. A surgeon who hands you a written timeline has had this conversation many times before.
When can I drive again, and does it matter which knee was operated on?
Why ask it
Go through your own combination: which knee, automatic or manual, how far you drive. Surgeons commonly want you off sedating pain medicine and able to stamp on the brake first, and the rules and insurers' expectations differ from place to place, so ask how it works where you live.
How long will I be off work or school, and what should the note say?
Why ask it
Walk the surgeon through a real day: the commute, the stairs, hours on your feet, what you lift. Students should ask about an elevator pass, extra time between classes and how long gym class is off. Sick leave and accommodations are the employer's or the school's call, so get the restrictions in writing and take them there.
When can I start running again, and what has to be true before I do?
Why ask it
A good answer names conditions such as no swelling, full motion and thigh strength close to the other leg. If all you get is a month number, ask what happens if that month arrives and the knee is not ready.
What tests do I have to pass before returning to sport, and who runs them?
Why ask it
Listen for strength measured against the other leg, hop tests, a look at how you land and cut, and sometimes a questionnaire about confidence. Being told a date with no testing at all is the worrying answer. Ask where the testing happens and whether it costs extra.
Realistically, how long until I am back to cutting, contact and competition?
Why ask it
Expect a range measured in many months, and ask what puts someone at the early end or the late end. Give your coach the later figure. Parents should hear this before promising anyone a season.
What is my risk of tearing this graft or the ACL in my other knee, and what lowers it?
Why ask it
The other knee is the part most people have not thought about. Ask about injury prevention training for landing and changing direction, and whether you should keep it up once you are cleared. If a teenager is going back to the same sport, ask the surgeon to be blunt.
What happens if I am cleared to play but still afraid to trust the knee?
Why ask it
Plenty of athletes pass the physical tests and still hesitate on the first hard cut. A good surgeon treats that as part of rehab and not a character flaw, and can say who helps with it: the therapist, a sports psychologist or a slower return plan.
How often will I see you after surgery, and who makes the final call that I am cleared: you or the therapist?
Why ask it
You want one named person deciding, with the other's findings in front of them. If the surgeon signs off without the therapist's test results, ask what the decision is based on.
What might never feel quite the same, even if everything goes well?
Why ask it
Discomfort when kneeling, a numb patch, a click, a thigh that stays smaller for a long while. Hearing the likely ones now means they will not alarm you at month ten, and tells you what counts as normal for the graft you chose.
Getting the most from an ACL consultation
Practical guidance for the conversation itself
Before you walk in
Bring the scan, not only the report
Ask the imaging center for the MRI images on a disc or a shared link as well as the written report, and confirm the surgeon's office can open them. A surgeon who has looked at the pictures can talk about your knee. One who has only read the summary is talking about the summary.
Write down how the knee behaves
Note the date of the injury, what you were doing, and every time since that the knee has buckled, locked or swollen up again, with what set it off. That short log tells the surgeon more about how unstable the knee is than a description from memory.
Say what you want to get back to
Be exact: club soccer twice a week, a warehouse job, hiking with a pack, keeping up with small children. The advice on surgery versus rehab, and on which graft, turns on this, so say it in the first two minutes.
Mark the questions this visit has to answer
Nobody gets through 47 questions in one visit. If you have not decided on surgery, the first group is the visit. If you have, start at the graft and the surgeon's numbers, and ask whether the rest can go in a message to the office afterward.
Take someone to write
Graft names, month numbers and restrictions come quickly. Have a companion take notes, or ask whether you may record the explanation, so the decision at home is made on what was said and not on what you remember.
If the patient is your teenager
Let the athlete answer first
The surgeon needs to hear from the person whose knee it is: how it feels, how much the sport matters, how they feel about a long rehab. Agree beforehand that your teenager speaks first and you fill in what is missing.
Ask about growth early
If your child is still growing, raise it before the graft discussion, because it can change the technique and sometimes the surgeon. Ask how remaining growth is judged and how many patients of that age the surgeon treats.
Keep the season out of the driver's seat
Tryouts, recruiting and a coach's hopes are real pressures, and none of them should set the return date. Ask the surgeon to explain the testing that decides it while your teenager is in the room, so the rule comes from the surgeon and not from you.
Plan school before the date is set
Ask how many days of class are usually missed, when carrying a backpack on crutches is realistic, and what the note for the school should say. Then ask the school how it handles elevator access, late passes and gym class, since each one does it differently.
Watch the middle months
The hard stretch for a young athlete is often not the first week but the long middle, when the team is playing and they are doing exercises in a clinic. Ask the surgeon and the therapist what they suggest for staying involved with the team, and who to talk to if your child's mood drops.
Comparing surgeons and second opinions
Ask each one the same five
Surgery or rehab for me, which graft and why, how many of these a year, how re-tears are tracked, and what decides return to sport. Putting the same five to every surgeon makes the differences plain.
When the graft advice differs
Two good surgeons can recommend different grafts for the same knee. Ask each why the other might have chosen as they did. The reasons tell you whether the difference is about your knee or about what each surgeon does most.
Keep working on the knee while you decide
A second visit can be weeks away. Tell the first surgeon you are getting one and ask whether anything in the knee, such as a meniscus that locks, makes that too long, and what to stay away from until then. Carry on with the prehab in the meantime: it is the same work whichever surgeon, graft or route you end up with.
Take the same MRI to both
Have the first office send the images and the notes ahead, and confirm they arrived, so the second surgeon is reading the same knee and not ordering a new scan. Whether a second opinion is covered, and whether it needs a referral, depends on your insurer or health system, so ask before you book.
Setting up the months after
Book the therapist before the surgery
Meet the physical therapist during prehab if you can. They learn what your knee was like beforehand, you learn the first exercises with no pain in the way, and the first appointments after surgery are already on the calendar.
Get the house ready for two weeks
Decide where you will sleep, how you will get to the bathroom on crutches, and who brings food and ice. Put what you use every day at a height you can reach without bending the knee or climbing.
Put the paperwork in motion
Ask the surgeon's office for the work or school note and any forms early, and ask your employer or school what they need and by when. Leave, pay and accommodations work differently everywhere, so get the local answer in writing.
Keep a one-line rehab log
Each day, note swelling, how straight and how bent the knee gets, and what you did. It gives the surgeon and therapist something to read at each visit, and on a slow week it shows you how far the knee has come since the first one.