Anterior Cruciate Ligament

The anterior cruciate ligament is one of the major ligaments of the knee joint.  It is located in the middle of the knee along with another major ligament aka posterior cruciate ligament. 

The anterior cruciate ligament starts in the lower end of the femur or the thigh bone and ends on the upper end of the tibia or the shin bone.  The anterior cruciate ligament helps stabilize the knee and prevents the sliding of the tibia under the femur.

Anterior cruciate along with the posterior cruciate ligament help provide rotational stability to the knee joint.  An anterior cruciate ligament injury can happen in a sports related event, from a motor vehicle accident or even in daily activity. 

It happens due to forceful twisting or hyperextension injury to the knee joint.  The tear usually happens due to pivotal injury that is abrupt change in rotational direction of the knee with the foot fixed on the ground or with the rapid deceleration of the knee.

MRI of the knee showing partial ACL tear

MRI of the knee showing partial ACL tear

Examples of events leading to ACL injury may be sudden change of direction or cutting or sudden stopping, landing from a jump in an incorrect manner or direct contact or collision such as in a football tackle or a motor vehicle accident. 

At the time of injury, a pop can be felt or heard and is usually associated with the feeling of giving away. Within a next couple of hours, the knee is usually swollen and painful and has a buckling sensation especially while twisting or pivoting movements.

An ACL injury may be associated with injuries to other structures of the knee like the meniscus on the medial collateral ligament and occasionally a bone bruise. 

These additional injuries may have additional presentations in the form of tenderness on the inner side of the knee and inability to bear weight. Initial injury is treated with rest, ice, elevation and compression with bandage or ace wrap (RICE protocol).

The patients following acute injury to the knee with swelling should seek medical attention. The history and physical examination can be suggestive of diagnosis of ACL tear.  X-rays are performed to rule out any obvious bony injuries. 

In patients with high index of suspicion for a ligamentous injury, an MRI scan is usually performed.  Diagnosis of an ACL injury or tear is usually by an MRI or on arthroscopic examination especially with patients in whom MRI is contraindicated.

ACL injury can be in the form of complete tear or rupture or an incomplete tear in which only a few fibers of the ACL are injured, and the remaining ligament is intact. 

Treatment of ACL injury usually depends on the patient’s age, activity level, physical requirements, and lifestyle as well as the injury being complete or incomplete. 

In patients with high grade injury or complete tear, in young patients with high activity level and demand and a physical examination showing laxity of the knee will usually require a surgical treatment option for return to optimal level or return to preinjury level of activity and lifestyle.

In older patients with low activity level or demand or in patients with high-grade arthritis or patients with low-grade partial tears, a conservative treatment plan can be followed with optimal results.  Patients who are treated conservatively or nonoperatively are usually treated in a knee brace along with physical rehabilitation.

Patients who are older and have advanced knee arthritis are usually treated as if for their arthritis appropriately conservative or operative, most common surgery being Joint replacement. 

In younger patients with low-grade tear or partial tears, gradual ACL rehabilitation program is followed before they can return to preinjury level.  Rehabilitation may take 4 to 6 months or longer especially in athletes.

Patients who are planned to be treated operatively usually undergo either of the two surgical plans:

  • ACL repair
  • ACL reconstruction.


Anterior cruciate ligament repair has recently become a successful option for carefully selected patients.  Patients with pull off or avulsion of ACL from the lower end of the thigh bone or the femur are good candidates for ACL repair. 

This surgery allows retention of the native ligament and hence its lining and blood supply which allows early healing and recovery.  The repair can be augmented with the use of artificial sutures and tapes to support the native ligament during the period of healing and allow early rehabilitation.

The surgery is performed arthroscopically through small incisions using arthroscope and arthroscopic instruments.  A final decision to do a repair versus reconstruction is usually taken at the time of the surgery itself, though preoperative MRI can be helpful in making a treatment plan.

The postoperative recovery from an ACL repair is similar to that of ACL reconstruction except that the recovery is faster, and rehabilitation is also quicker.  The risks and complications for ACL repair are essentially the same as for ACL reconstruction except that there is decreased morbidity from the graft harvest site as there is no graft harvest in the surgery.


ACL reconstruction is usually performed in patients with midsubstance ACL tear as these tears are not amenable repair.  The native ligament needs to be removed and replaced with substitute.  The surgery is usually performed arthroscopically through small incisions and appropriate substitute graft is used. Possible options of substitute graft include:

  • Quadriceps tendon graft
  • Patellar Bone tendon bone graft
  • Hamstring tendon graft
  • Cadaveric Allograft

The type of graft to be used depends on the patient’s level of activity and requirement, it being a primary or a revision surgery, patient’s characteristics as well as patient’s decision.

  The hamstring graft, bone tendon bone graft or the quadriceps graft are usually harvested from the patient’s same knee or occasionally from the other knee in cases of revision surgery. 

An allograft is a cadaveric tendon graft which has been stored aseptically and is prepared and used to substitute the anterior cruciate ligament. Other associated injuries like meniscal tear can be taken care of at the same time as the ACL repair/reconstruction.


The patients are usually seen by the physician and appropriate preoperative investigations including advanced imaging, blood work and ECG and chest x-rays as needed are done. 

The patients may also need clearance from their primary care physician and anesthesiologist before the surgery.  The patients are instructed to come to the hospital two hours in advance.  The patients are taken to the preoperative area where they are seen by the anesthesiologist and appropriate procedure performed before the patient is taken to the operating room.

A nerve block is usually performed in the pre-operative area. In the operating room the patient usually is given general anesthesia before being positioned for the surgery.


Following the repair or reconstruction surgery, the patients are usually provided a knee brace and crutches and discharged home the same day. Patients are advised to use ice and elevation to control the swelling and pain for the initial few days and refrain from strenuous activities. Ice should be used for 15-20 minutes as a time as frequently as possible.

The patients are asked to ambulate with crutches under supervision for the first 24 hours, due to nerve block on the same leg causing it to be numb and weak.  The nerve block helps during the surgery as well as after the surgery by controlling pain.

Patients are encouraged to take care activities of daily living from the next day. They are allowed weight bearing with knee brace and crutches. They are provided with pain medications in the postoperative unit as well as for home.

Patients are asked to take off their dressing in 72 hours.  They can shower and change their dressing to a dry dressing.  Patients are encouraged to take nutritious and healthy food and are asked to take over-the-counter laxatives in case of the constipation.

Patients are usually seen in the outpatient office in one week where adjustment of the brace is performed, and the wound is examined.  Patient is usually enrolled in the physical rehabilitation program following the reconstruction surgery and are followed in office regularly at 3 to 4-week interval.

A gradual recovery from ACL takes place over the span of 5 to 8 month or longer. Patients are encouraged to strengthen quadriceps to same strength as on to the other side before they start any professional games.


Physiotherapy is an important part of the treatment and recovery after ACL surgery. It is also important for patients being treated non-operatively. Motivation on the part of the patient is key to recovery from ACL injury.

Physical Therapy should be started as early as possible. Preoperative physiotherapy is also helpful to understand and prepare the knee for surgery. The initial aim of physical therapy is to regain range of motion, reduce swelling and achieve full weight bearing.

This is carried out under supervision of a physiotherapist and physician and includes sessions as well as home based physical therapy as instructed. Rehabilitation will involve proprioceptive exercises and muscle strengthening activities such as bike riding, swimming etc.

Cycling can begin at 2 months, jogging can generally begin at around 3 months. The graft is strong enough to allow sport at around 6 months however other factors come into play such as confidence, fitness and adequate fitness and training.

The rehabilitation and overall success of the procedure can be affected by other associated injuries to the knee such as injury to the meniscus, articular cartilage or other ligaments.


Complications are not common but can occur. It is pertinent that patients understand prior to making the decision of have this operation so you can make an informed decision on the advantages and disadvantages of surgery. These can be:

Medical (Anesthetic) complications

Medical complications include those due to your general wellbeing and due to Anaesthesia given before and during the surgery. These include but not limited to:

Allergic reactions to medications, excessive blood loss requiring transfusion with its low risk of disease transmission, heart attack, stroke, kidney failure, pneumonia, bladder infections.

Complications from nerve blocks such as infection or nerve damage. Serious medical problems can lead to ongoing health concerns, prolonged hospitalization.

 Surgical Complications:

  • Infection
  • Deep vein thrombosis and its subsequent complications including pulmonary embolism and possible death
  • Excessive swelling & Bruising
  • Joint stiffness
  • Tingling and numbness
  • Graft failure
  • Damage to nerves or vessels
  • Hardware problems
  • Donor site problems
  • Residual pain
  • Reflex Sympathetic Dystrophy

Some of these conditions may require hospitalization, aspiration, injections or even surgery

Certain patient population is at a higher risk for complication which include but are not limited to:

  • Previous failed surgeries
  • Smoking
  • Seizures
  • Obstructive sleep apnea
  • Obesity
  • High blood pressure
  • Diabetes
  • Other medical conditions involving your heart, lungs or kidneys
  • Medications, such as aspirin, that can increase bleeding
  • History of heavy alcohol use
  • Drug allergies
  • History of adverse reactions to anesthesia


  • Suspected cardiac problem: severe chest pain or pressure, shortness of breath, tightness in chest, pain in left arm, jaw pain, dizziness or fainting, unexplained weakness or fatigue, rapid or irregular pulse, sweating, cool, clammy skin, and/or paleness
  • Suspected Stroke: trouble speaking, changes in vision, confusion or other change in mental status
  • Suspected venous thrombosis: swelling of the legs, ankles, or feet, discomfort, heaviness, pain, aching, throbbing, itching, or warmth in the legs, sudden shortness of breath, chest pain, coughing up blood, rapid or irregular heart rate
  • Suspected Sepsis: high grade fever, with shivers associated with fatigue, dizziness, racing heart, pale or discolored skin, sleepy, difficult to rouse, confused, short of breath
  • Heavy bleeding from the surgical site
  • Severe allergic reaction with trouble breathing, swelling, hives


  • temperature more than 101 degrees Fahrenheit
  • increased pain or tenderness near the incision
  • poor pain relief
  • signs of infection: increased swelling, redness, increased drainage, increased warmth, pus, foul smell, bleeding at the incision, incision coming apart
  • inability to feel or move fingers or toes
  • pale blue, white or abnormally cold fingers or toes
  • nausea (upset stomach) or vomiting (throwing up) that won’t stop
  • increased tiredness
  • a generally worse feeling than you had when you left the hospital
  • problems urinating, severe constipation or severe diarrhea
  • a concern about any other symptoms that seem unusual


ACL reconstruction is the time-tested procedure which has given consistently good results especially in younger and athletic population as well as in patients with high demand lifestyle.  ACL repair is a recent advancement and has shown promising results in appropriately selected patients.

ACL surgery along with postop rehabilitation can give good results and take the patient back to preinjury level in 6 to 12 weeks.  It does require high level of motivation on the part of the patient as well as skills on the part of the surgery along with a good physical therapy and rehabilitation team for an optimal recovery.

Patients who are not a good candidate for arthroscopic surgery can be treated conservatively in a knee brace along with physical rehabilitation with fair results.

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Based on 116 reviews
I had an extremely friendly and personalized medical consult with Dr Karkare. Dr Karkare was very knowledgeable and very professional. His communication skills was extremely good and explained my medical condition in very simple words. The office visit was very helpful in understanding my medical condition. Thank you Dr Karkare
Padmanabhan Nagaraj
20:49 25 Sep 23
Dr. Karlkare and his staff were excellent. Dr. Karkare explained everything clearly and took his time getting to know my Dad.
Anna Acker
22:46 07 Sep 23
Dr Vedant Vaksha had done emergency surgery in 2020 after a traumatic injury.His office at Complete Orthopedics handled the continued care thereafter.Dr V and his staff had been Professional and friendly throughout the process, taking the time to explain all the questions on how to proceed and what to expect.Whenever I needed to speak with Dr V or the office they were a phone call away, without waiting or calling several numbers like in so many other medical offices.The office was accommodating to scheduling to my needs at all times. Dr Vedant Vaksha earned the following5 out of 5 stars, highly recommended.
John Kuey
20:58 05 Sep 23
Dr. Vaksha helped me recover from an injury. I am very thankful that he took the time to explain the best treatment for my injury. Also thankful for the wonderful office staff!
Joseph Castelli
22:30 02 Aug 23
The office is wonderful!… Dr Paresh was very helpful and attentive and made my sister in laws recovery so much better.. Thank you for everything
Jazz Lorenzo
17:48 14 Jul 23
The ladies are very welcoming, the service is great, the doctor is very professional and caring and the building is super clean. I really like to come here, the atmosphere is very friendly... Come and you will love it too.
Joan Carasco
14:41 30 Jun 23
Dr. Nakul Karkare is awesome! And patriotic! Thank you, Dr. Karkare for displaying the American Flag in your waiting room, honoring and mourning our military personnel, this Memorial Day, who died while serving in the United States Armed Forces.
00:52 30 May 23
Excellent and skilled orthopedic practice specializing in joint replacements. Dr Karkare was trained at the Hospital for Special Surgery and has excellent results, as do his associates!! Would gladly refer family members to the practice!!
00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
Victoria DeMatteo
19:49 10 May 23
I'm very happy St. Catherine's sent me to this office for treatment after I broke my collar bone! Unfortunately the break was too severe to repair on its own and I had to have it rebuilt a week after the injury. Dr. Vaksha did a great job fixing it. I'm three months out, and I have full use of the arm and shoulder. The whole office staff is very professional, accommodating, and welcoming. I hope to not need orthopedic services again, but Dr. Vaksha will be my number one choice if I or anyone in family suffers such am injury.
Tina Rivera
20:42 08 May 23
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

Please take a look at my profile page and don't hesitate to come in and talk.