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What is ACL surgery?
The anterior cruciate ligament (ACL) is a strong band in the centre of the knee. It helps control forward movement and rotation of the shin bone, especially during cutting, pivoting, landing and sudden stops.
An ACL injury often happens during soccer, basketball, skiing, football or another activity involving a quick change of direction. Some tears happen through a collision, fall or awkward step. People commonly describe a pop, rapid swelling and a knee that later feels as if it may give way.
ACL reconstruction is an operation that replaces the torn ligament with a tendon graft. The surgeon usually works through small arthroscopic incisions, removes or preserves parts of the damaged ACL as appropriate, creates bone tunnels and secures the graft in the position of the original ligament. Over time, the graft becomes incorporated into the knee.
A partial or complete ACL tear does not automatically mean you need surgery. Some people regain enough stability with physiotherapy, strength training and activity changes. Reconstruction is more likely to be discussed when:
- the knee repeatedly gives way;
- you want to return to pivoting or cutting sport;
- your work requires climbing, turning, carrying or unpredictable movement;
- the ACL tear occurs with repairable meniscus or other ligament damage; or
- instability continues despite a structured rehabilitation program.
A small number of tears may be suitable for a repair that preserves the ACL rather than replacing it. Eligibility depends on the tear location, tissue quality, time since injury and available technology. Your surgeon should explain whether reconstruction, repair or non-operative care is the most reasonable option for your knee.
Browse orthopaedic surgeons offering private ACL care in Canada.
ACL graft options and surgical techniques
There is no single graft that is right for everyone. Your surgeon may recommend an autograft taken from your own body or, in selected situations, an allograft from screened donor tissue.
The choice depends on age, activity level, sport, work, knee anatomy, previous surgery, other injuries and the surgeon’s experience. The American Academy of Orthopaedic Surgeons’ ACL guideline supports discussing graft selection as a shared decision. Return to sport is not determined by graft type alone; rehabilitation progress and objective testing matter.
ACL reconstruction with meniscus repair
ACL tears often occur with a torn meniscus. If the meniscus can be preserved, the surgeon may repair it during the same operation. This can protect important cushioning tissue, but the repair may change your early rehabilitation.
You may need a brace, crutches, limits on weight-bearing or restrictions on deep knee bending while the meniscus heals. The exact plan depends on the tear pattern and repair. A combined operation may also increase operating time, facility costs and follow-up needs. Ask whether your quote assumes ACL reconstruction alone or includes possible meniscus treatment.
Learn more about private meniscal repair and how it differs from removing an unstable fragment. ACL reconstruction is commonly performed using private knee arthroscopy.
How much does private ACL reconstruction surgery cost in Canada?
How we estimate surgical costs: Ranges are estimates drawn from our network of 100+ private clinics and surgeons, and they're intentionally broad. Two people seeking the same procedure can receive very different quotes depending on province, surgeon, facility fees, and case complexity. Published prices aren't always comparable either—some are complete bundles, others exclude consultation, imaging, or follow-up. Only the clinic can give you an exact, itemized quote.
Private ACL reconstruction in Canada commonly ranges from $15,000 - $28,500,. The main drivers are the complexity of the operation, whether another procedure such as meniscus repair is needed, and what the clinic’s package includes.
See the full private ACL surgery cost guide for inclusions, financing, tax considerations and questions to ask about a quote.
Ask for a written, itemized quote covering the surgeon, facility, anaesthesia, graft or donor tissue, implants, brace, follow-up and complication policy. Extended benefits may cover physiotherapy or bracing even when they do not cover the operation.
ACL surgery: what to expect
ACL reconstruction usually takes about 1 to 2 hours, although a revision or combined meniscus, cartilage or ligament procedure can take longer. Most people go home the same day after they meet the clinic’s discharge criteria.
Before the operation
You will review the consent, graft plan, allergies, medications and the possibility of treating meniscus or cartilage damage found during arthroscopy. The team confirms the correct knee and checks that swelling and range of motion are suitable for surgery.
Anaesthesia
Most ACL reconstructions use general anaesthesia, often with a regional nerve block to help manage early pain. The anaesthesiologist will recommend a plan based on your health, procedure and facility.
Arthroscopy and knee assessment
The surgeon makes small incisions and inserts a camera. They examine the ACL, menisci, cartilage and other structures. A repairable meniscus may be treated during the same operation if this was discussed in advance.
Graft preparation
If an autograft is planned, the surgeon harvests the chosen hamstring, patellar or quadriceps tendon and prepares it to become the new ACL. An allograft is prepared from screened donor tissue.
Tunnel creation and fixation
The surgeon creates carefully positioned tunnels in the thigh bone and shin bone. The graft is passed through and secured with devices such as screws, buttons or anchors. Position and tension are checked before closure.
Recovery area and discharge
You wake in the post-anaesthesia care area. The team checks pain, nausea, circulation and safe mobility. You receive written instructions for the dressing, brace, crutches, medications, exercises, follow-up and urgent symptoms.
Expert Surgeon Insight
Dr. Anthony J Costa: What you need to know about ACL surgery consultations
During your consultation with an orthopaedic surgeon, there are many aspects of your injury and health history that need to be thoroughly reviewed. You can expect to have an in-depth discussion about:
- How the injury occurred
- Initial treatment and any subsequent treatment received since the injury
- Other symptoms like locking or ongoing instability
- Previous history of injury or knee problems
- Past medical and surgical history
- Other medications and allergies
- Occupation
- Recreational activities and other functional demands
- Smoking status, alcohol and other substance use
In addition to reviewing your history, your surgeon will also perform a detailed physical examination including assessment of:
- Height and weight
- Gait and overall knee alignment
- Swelling in the knee or other wound issues
- Areas of tenderness
- Knee range of motion
- Patella tracking
- Stability of all knee ligaments
- Special tests to identify damage to other important knee structures
- Neurovascular function
- Joints above and below your knee
Your surgeon will also review x-ray images of your knee, and other advanced imaging studies such as MRI (and sometimes CT scans).
Once all of the above has been reviewed, your surgeon will discuss with you the treatment options, and help you make a decision about the most appropriate course of action, depending on your unique situation. If surgery is chosen, you will have further discussions about technical aspects of the procedure, risks and benefits, recovery timelines, etc.
At Ortho South (in Calgary, Alberta) we book initial consultations for an hour to ensure there is enough time to fully understand your function, ideas, feelings, and expectations, as well as to answer the many questions you are likely to have!
What can I expect from the ACL reconstruction surgery recovery process?
The recovery process varies patient to patient. Your recovery might look quite different, so please seek further guidance from your surgeon. In general here is what you can expect:
Week 1:
- Pain, discomfort, emotion, more pain, stiffness, frustration. Week 1 is not fun.
- Goals: Pain management, inflammation control, surgical graft protection, initial basic movement.
- Activities:
- Same day discharge (usually).
- Crutch-assisted walking with little physio-directed weight bearing.
- Basic exercises such as ankle pumps, quadriceps contractions, and passive range of motion exercises (only as directed).
- Pain medication management and wound care (it will be advantageous to have a friend, family member, or caretaker support you for both in the first few days).
Weeks 2-4:
- The next 3 weeks are still characterized by significant discomfort, swelling, frustration, and emotional highs and lows.
- Goals: Restore knee extension to 0 degrees, achieve 90-120 degrees of flexion, quadriceps activation, start rehab.
- Activities:
- Continuing to use crutches, and potentially transitioning to just one crutch or a cane.
- Increase walking and weight-bearing, practicing normal walking patterns to avoid developing a limp.
- Daily exercises and physio focused on a developing range of motion and simple strength building exercises.
Weeks 5-12:
- Focus and diligence on exercises will likely pay off, and you'll likely be able to walk again unassisted and return to driving.
- Goals: Achieve fill range of motion (0 to 130 degrees), increasing physical therapy, walk unassisted, resume most normal activities.
- Activities:
- More challenging physical therapy in order to improve range of motion and build strength.
- Daily exercises. Possibly low impact activities like swimming and stationary cycling (only if cleared by healthcare team).
- Walking longer distances—transitioning from the use of walking aids around week 6-8.
Weeks 13-52:
- The worst of the recovery is likely behind you. But you'll need to stay on top of physical therapy and listen carefully to your body in the year post operation (and beyond).
- Goals: Return to low impact sports and hobbies, achieve 90% strength symmetry between legs, focus on long-term knee health.
- Activities:
- Physical therapy may continue the entire first year post operation, gradually bringing you back to your activity levels pre-surgery.
- You will be able to return to low impact sports like golf, tennis, swimming, or cycling. For anything high impact, please consult your surgeon and physio. Most functional recovery happens within one year of surgery, but many patients need to continue working up to pre-injury levels of activity for up to 2 years.
Read our recovery guide for an in-depth overview on ACL Recovery.
What is Surgency?
As a family doctor in the public system, I believe transparency is a form of care. I created Surgency to help my patients struggling on long waitlists who wanted to understand all their options for timely medical attention.
Surgency is a free resource designed to empower and educate—helping you understand private pathways and find accredited surgeons within Canada. I hope Surgency brings you clarity.
Dr. Sean Haffey
Why do people choose to have ACL surgery done privately?
If knee instability/ pain is keeping you from sport, work, sleep, or simple daily movement, time matters. Exploring a private pathway gives you more choice, control, and flexibility while staying within Canadian regulations.
Timing
The number one reason you might consider a private ACL surgery is time. Instead of waiting months for surgery, private clinics often offer surgery within weeks. For many, this generally means less pain and faster return to sport and daily activities.
Choice and control
Going private generally gives you a sense of control, which can be reassuring during a difficult time. When you choose a private surgeon, you can:
- Select a certified orthopaedic surgeon and an accredited clinic that fits your needs.
- Select the clinic location (often out-of-province).
- Plan surgery around your own schedule.
Clarity upfront
Private pathways typically provide a clear quote and date, so you can arrange time off, caregiver help, and rehab. This certainty can ease anxiety and help families plan for recovery.
Preventing further decline
- Instability risks: Repeated “giving‑way” episodes while waiting can damage meniscus and cartilage, increasing arthritis risk and making surgery more complex.
- Deconditioning: Prolonged delay can worsen quad/hip weakness and neuromuscular control, lengthening rehab.
- Season and scholarship timelines: Athletes may protect opportunities by aligning surgery and rehab with key dates.
- Mental load: Reduces time living with knee uncertainty, bracing limits, and activity restrictions.
Choosing a surgeon and clinic
Choosing your surgeon is one of the benefits of going the private route. Here is what to consider when making your choice.
What to look for
- Experience. Ask how many ACL surgeries they perform each year. Volume and familiarity with the procedure can matter.
- Credentials and training.
- Confirm your surgeon is a licensed through their provincial college (e.g., CPSO in Ontario, CPSBC in BC, CPSA in Alberta).
- Ensure they are certified through the the Royal College of Physicians & Surgeons of Canada (FRCSC).
- Specialization. Some surgeons increase their expertise in this area by pursuing additional 1-2 year fellowships for orthopaedic sports medicine, ACL reconstruction, arthroscopy, ligament reconstruction.
- Accreditation of the clinic or hospital. Make sure the clinic is accredited by national bodies such as Accreditation Canada or the Canadian Association for Accreditation of Ambulatory Surgical Facilities (CAAASF).
- Support services. Look for clinics that offer coordinated aftercare.
Questions to ask during your ACL surgery consultation
Another benefit of private surgery is time spent with the surgeon. The consultation will be between 30-60 minutes (but possibly 2hours for complicated cases). Your surgeon should answer most of the questions below, but be sure to bring 5-7 that are important to you.
Surgeon and surgery plan
- How many surgeries do you perform each year?
- What are your infection rates? Re-tear rates?
- Do you treat athletes at my level?
- What exactly is torn (ACL only vs meniscus, cartilage, MCL/LCL, posterolateral corner)?
- What graft do you recommend for me (hamstring, patellar tendon BTB, quadriceps, allograft) and why?
- Fixation: what devices will secure the graft (screws, buttons), and long‑term outcomes with them?
- What anesthesia do you recommend (local/regional + sedation vs general) and why?
- Is this outpatient or will I stay overnight? In a hospital or ambulatory surgery center?
Post-surgery
- What’s my expected timeline for:
- Off crutches, out of brace
- Jogging
- Cutting/pivoting drills
- Return to sport clearance (based on objective testing)
- How closely do you coordinate with my physiotherapist? How often are follow‑ups?
- What signs after surgery should prompt me to call you or go to the ER?
- Who do I contact for questions after surgery (direct line/email)? How quickly do you typically respond?
- If complications occur, how are they managed and by whom?
Costs and logistics
- What exactly is included in my quote? What could add cost?
- If a complication occurs, how are costs handled? Is there a revision policy?
- How are follow‑ups managed if I’m traveling from another province?
If you're currently interested in private surgical pathways within Canada, you can click here for a list of providers.
Frequently asked questions
How do I know if ACL reconstruction surgery is right for me?
ACL reconstruction may be reasonable when instability—not pain alone—is stopping you from doing what matters and a careful assessment shows that surgery is likely to help you reach your goals.
Signs reconstruction may fit your goals
- Your knee repeatedly gives way despite rehabilitation.
- You want to return to soccer, basketball, skiing or another pivoting sport.
- Your job requires climbing, carrying or sudden changes of direction.
- You have a repairable meniscus tear that may benefit from a stable knee.
- You have additional ligament damage that makes non-operative treatment less reliable.
- You understand the rehabilitation commitment and can participate consistently.
When non-operative care may be reasonable
Some people do well with physiotherapy, strength and balance training, bracing and avoiding high-risk movement. This may be appropriate if the knee feels stable during desired activities, there is no repeated giving-way and your lifestyle does not require cutting or pivoting.
When to seek assessment sooner
Get prompt medical attention for a locked knee, major swelling after a new injury, worsening instability, inability to bear weight, signs of infection or calf swelling. A locked knee may indicate a displaced meniscus tear that needs timely assessment.
Do I need a referral?
Yes and no—you can reach out to any of the private surgeons listed on Surgency without a referral. Their intake teams are happy to answer questions, explain what they treat, share pricing ranges, and walk you through next steps.
However, to book a formal consultation with the surgeon, you'll typically need a referral from your family doctor or nurse practitioner. Don't have one? Many of the clinics can help coordinate a virtual GP appointment to get the referral paperwork sorted. All surgeons listed on Surgency offer virtual initial consultations, so you don't need to travel until you and the surgeon have agreed on a plan.
Before your consultation, expect the clinic to request relevant medical records and recent diagnostic imaging (X-ray, MRI, CT, ultrasound, lab work, etc.). Having these ready speeds up the process and lets the surgeon give you specific guidance on your very first call.
What are the risks if I delay or don't get ACL surgery?
The answer to this question depends heavily on your unique circumstances. Please consult your surgeon for tailored advice.
In general, delaying ACL surgery by 6-12 months presents several potential risks:
- Meniscal and cartilage damage
- Developing osteoarthritis and irreversible joint degeneration
- Worse outcomes post-surgery in terms of pain and function
- Further injuries, especially for young and/or active individuals
If you need ACL surgery, and do not get it, then you may risk:
- Chronic instability
- Subsequent injuries to your meniscus and cartilage
- Substantial limitations to daily life (i.e. unable to return to sport or active hobbies)
- Disability
How much does Surgency cost?
Surgency is free for patients, funded for by surgeons.
Surgeons—who meet our listing criteria—pay a flat fee to list on the Surgency platform. To maintain objectivity, there are no commissions, referral fees, nor any ranking or recommending one surgeon over another.
Surgency is patient-first. Our goal is to make the process of finding a private surgeon as simple as possible. You choose who to contact. Learn more in our Advertising Policy.
What are the risks involved with ACL surgery?
Here are the main risks of ACL surgery (ACL reconstruction). Most people do well, but it’s important to understand possible complications and how surgeons reduce them.
Common, usually temporary
- Pain, swelling, bruising
- Stiffness or trouble fully straightening/bending the knee (arthrofibrosis risk is highest in the first 6–12 weeks)
- Numbness near small skin nerves around the incision
- Donor-site soreness/weakness (if your own tendon is used): front-knee pain with patellar tendon graft; hamstring weakness with hamstring graft; quad weakness with quadriceps graft
Occasional
- Infection (superficial or deep joint infection)
- Blood clots (DVT/PE)
- Bleeding/hematoma
- Hardware irritation (screws/buttons) or need for removal
- Loss of motion requiring aggressive therapy or, rarely, a manipulation/arthroscopic lysis of adhesions
- Persistent pain (anterior knee pain, kneeling pain)
- Graft stretch-out leading to looseness
Less common but important
- Graft failure/re-tear (risk higher if returning to pivoting sports too early, poor neuromuscular control, or with allograft in young athletes)
- Tunnel malposition or graft impingement causing instability or stiffness (may need revision)
- Meniscus/cartilage damage not healing or progressing despite treatment
- Nerve or vessel injury (rare)
- Complex regional pain syndrome (rare)
Risk modifiers (raise or lower risk)
- Higher risk: multiple-ligament injuries, poor pre-op motion/swelling control, smoking/nicotine, diabetes, obesity, returning to sport before passing strength/hop/movement tests, younger age in pivoting sports
- Lower risk: achieving full extension and good quad activation before surgery, experienced surgeon, anatomic tunnel placement, infection prevention protocols, structured physio, objective return-to-sport criteria
How surgeons reduce risks
- Prehab to restore motion and reduce swelling before surgery
- “Anatomic” reconstruction with careful tunnel placement and secure fixation
- Infection prevention (antibiotics, sterile technique)
- Early extension, progressive rehab, and close follow-up
- Using objective return-to-sport testing (strength symmetry, hop tests, movement quality, psychological readiness) rather than time alone
Red flags after surgery
- Fever, chills, wound drainage, spreading redness
- Calf pain/swelling, shortness of breath (possible clot)
- Inability to straighten the knee by 2–3 weeks despite therapy
- Sudden pop with swelling and instability after a twist
How do I prepare for ACL surgery?
Your surgeon’s instructions come first. Preparation usually focuses on reducing swelling, regaining full extension, activating the quadriceps and planning for safe recovery.
Prehabilitation
Before surgery, many teams want the knee to be “quiet”: limited swelling, full straightening, good bending and a normal or near-normal walking pattern. Attend prescribed physiotherapy and practise the exercises you will use after surgery.
Medication and health review
Provide a complete list of prescriptions, non-prescription drugs and supplements. Follow specific instructions for anticoagulants, diabetes medication, anti-inflammatory drugs and fasting. Do not stop a prescribed medicine without direction.
Nicotine can interfere with healing and increase complication risk. Ask for support to stop smoking or vaping before surgery. Control diabetes and discuss any skin infection, illness or dental infection with the surgical team.
Prepare your home
- Remove loose rugs, cords and clutter.
- Set up a chair with arms and keep essentials within easy reach.
- Arrange ice or a cold-therapy plan only as directed.
- Prepare simple meals and hydration.
- Consider a shower chair and non-slip bath surface.
- Ask where to obtain crutches and a brace if needed.
Plan support, transport and work
Arrange a responsible adult to take you home and stay with you for at least the first night, or longer if advised. Discuss time away from work based on job demands. A desk-based role may resume earlier than work involving climbing, carrying, kneeling or driving.
What to bring
Bring photo identification, medication list, imaging or access instructions, insurance information if relevant, and loose clothing that fits over a dressing or brace. Leave valuables at home.
When can I return to sports or active hobbies after ACL surgery?
Approximately 90% of patients with ACL tears want to get back on the field or court ASAP. But, in general, recovery to the point of returning to sport takes 9-12 months, with some high impact sports requiring up to 24 months. 65% of patients with ACL tears are able to successfully return to pre-injury levels of activity.
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