[8] Graft options for ACL reconstruction include: An accessory hamstring or part of the patellar ligament are the most common donor tissues used in autografts.

The braided segment is threaded through the heads of the tibia and femur, and its ends are fixed with screws on the opposite sides of the two bones.

[citation needed] Unlike the patellar ligament, the hamstring tendon's fixation to the bone can be affected by motion after surgery.

[10] A Cochrane review in 2011 found insufficient evidence to suggest whether a hamstring versus patellar ligament graft was superior.

[11] It found that individuals receiving hamstring autografts had reduced flexion (bending knee) range of motion and strength.

[citation needed] The main surgical wound is over the upper proximal tibia, which prevents the typical pain experienced when kneeling after surgery.

[citation needed] A 2011 Cochrane review, found no significant difference in long term outcome between patellar and hamstring autografts.

[11] Those receiving patellar autografts had improved static stability but a loss of extension (straightening knee) range of motion and strength.

The beginning rehab for the ACL graft knee is focused on reducing swelling, gaining full range of motion, and stimulating the leg muscles.

However, the observed difference in failure rates is small enough that both are still regarded as viable options for primary ACL reconstruction.

Modern fixation methods avoid graft slippage and produce similarly stable outcomes with easier rehabilitation, less anterior knee pain and less joint stiffness.

[medical citation needed] A new approach to treating ACL tears was developed at Boston Children's Hospital and is currently in clinical trials.

[25] In a study by the American Journal of Sports Medicine, they looked at a young and active population two years post surgery using the BEAR technique.

There is insufficient re-vascularization of the ligament after complete rupture, which limits its ability to heal and necessitates reconstruction surgery.

There is evidence that supports LARS as a viable option for reconstruction surgery in regards to complication rates and high patient satisfaction scores, when compared to traditional surgical techniques.

However, systematic reviews of the LARS in regarding graft stability and long term functional outcomes, have highlighted several important gaps in existing literature that requires future investigation.

[27] Autologous stem-cell transplantation using mesenchymal stem cells (MSCs) has been used to improve recovery time from ACL surgery, especially for athletes.

[citation needed] In order for MSCs to differentiate into an ACL, they must be placed in a proper scaffold on which to grow, and must be in a bioreactor that maintains a normal physiological environment for the cells to reproduce and proliferate effectively.

[28] The scaffold must have the mechanical properties of a healthy ACL to sustain the ligament while it is in its primary form and maintain normal knee movement.

The bioreactor must have similar properties to a knee joint so that when the ACL is inserted into the body, it is not rejected as foreign, which could cause infection.

Range of motion exercises are used to regain the flexibility of the ligament, prevent or break down scar tissue from forming and reduce loss of muscle tone.

After six months, the reconstructed ACL is generally at full strength (ligament tissue has fully regrown), and the patient may return to activities involving cutting and twisting if a brace is worn.

Correlational analysis studies show that greater attendance at rehab sessions correspond with fewer reported symptoms in the surgical knee.

Increased knee extensor strength and range of motion for those who participated in a pre-rehabilitation program in the first 3 to 6 weeks, but no significant change at 3 to 6 months.

[37] This phase begins immediately post surgery while the patient is still on crutches and in a removable knee brace, which they're projected to be using for seven to ten days.

Some of these goals include: reducing pain and inflammation, increasing range of motion, strengthening surrounding muscles, and beginning weight bearing exercises.

Lateral movement, jogging in a straight line, single-leg squats and exercises will start to be incorporated as patient begins to regain confidence in the knee.

[medical citation needed] Some exercises that can be performed are: By this time the range of motion should be greater than 110 degrees flexed and the patient's bodily mechanics like walking and light jogging should be back to normal (before operation).

In order for this to happen the patient must have full range of motion, continue maintaining strength and endurance, and be able to increase proprioception with agility drills.

[41] Another study, conducted by Baylor University, found that ACL reconstruction procedures using the bone-patella tendon-bone technique took 2.5 hours longer than using a hamstring graft.