Ligament tears are among the most common knee injuries, especially in athletes and active individuals. Some ligament injuries, such as many MCL tears, can heal without surgery. Others, particularly ACL tears, often require surgical treatment to restore knee stability and allow a safe return to sports and activity.
Dr. Gomoll offers both ACL reconstruction and ACL repair, including several graft options for reconstruction. For select patients with recent ACL tears, he also offers the FDA-approved BEAR® implant, an innovative technique that repairs the torn ACL without the need to harvest a tendon or use donor tissue.
What is ligament surgery?
Ligament tears are among the most common sports injuries. Some ligaments — like the MCL in the knee — can heal by themselves with bracing and rehabilitation. Others, most famously the ACL (anterior cruciate ligament), frequently require reconstruction or repair, especially in active patients who want to return to cutting and pivoting sports. Dr. Gomoll explains ACL reconstruction graft choices in this video.
Transcript
ACL reconstruction graft choices
Several graft options are available for ACL reconstruction, including your own hamstring, quadriceps, or patellar tendon, as well as donor (allograft) tissue. The best choice depends on a number of factors, including your age, activity level, and goals, which Dr. Gomoll will discuss with you during your consultation.
Current research does not support a single "gold standard" graft for every patient. Studies have shown similar outcomes and failure rates between commonly used graft options. Some research has found a higher rate of donor-site problems — such as pain, weakness, or kneeling discomfort — with patellar tendon grafts compared to hamstring or quadriceps tendon grafts. For this reason, graft selection is individualized based on each patient's needs and circumstances.
Read the studies:
The BEAR implant
The FDA-approved BEAR implant allows repair, rather than reconstruction, of select ACL tears. During the procedure, a collagen implant is placed next to the injured ACL to support the knee's natural healing response. No tendon harvest or donor graft is required.
The best candidates are patients with a recent ACL tear near the top of the ligament and enough remaining tissue to support healing. Dr. Gomoll has been performing this procedure since early 2022 and serves on the board of the nationwide BEAR registry, which tracks outcomes and helps advance ACL repair research.
Who is a candidate?
- ACL Reconstruction: Patients with a torn ACL, particularly active individuals returning to cutting, pivoting, or contact sports, as well as those with knee instability or associated meniscus injuries.
- BEAR Implant Repair: Patients with a recent ACL tear and sufficient remaining ligament tissue to support healing and repair.
- Non-Surgical Care: Some isolated MCL and PCL injuries, as well as selected lower-demand ACL patients, may be successfully managed with bracing and rehabilitation rather than surgery.
When ligament injuries occur alongside malalignment or cartilage damage, Dr. Gomoll may combine ACL reconstruction with an osteotomy or cartilage repair procedure to address all contributing problems at the same time.
Risks to understand
ACL surgery has a strong track record, but like any operation it carries risks. These may include infection, blood clots, knee stiffness, graft failure or re-tear, and discomfort related to graft harvest with certain reconstruction techniques. Because each graft option has a different risk profile, graft selection is individualized for each patient.
Recovery & return to sport
Recovery takes place over several months and progresses through multiple phases, beginning with restoring motion and quadriceps function, followed by strengthening and sport-specific training.
Return to cutting and pivoting sports is typically a milestone-based process that takes approximately 9–12 months. Progress is guided by strength, function, and recovery milestones rather than time alone. See our rehabilitation protocols and after-surgery instructions for more detailed recovery information, and share the appropriate protocol with your physical therapist.
Frequently asked questions
Which ACL graft is best — hamstring, quadriceps, or patellar tendon?
There is no single "gold standard." A pooled analysis of multiple ACL trials found no significant difference in outcomes between hamstring and patellar tendon grafts, but a higher complication rate with patellar tendon. A separate review of roughly 47,000 patients found similar failure rates between patellar tendon (2.80%) and hamstring (2.84%) reconstruction. The right graft depends on your age, activity, anatomy, and goals — which Dr. Gomoll discusses with you at your office visit.
What is the BEAR implant?
The BEAR (Bridge-Enhanced ACL Restoration) implant is an FDA-approved option that enables repair — rather than reconstruction — of select ACL tears. A collagen sponge is placed between the torn ends of the ACL to support the knee's own healing, with no tendon harvest and no donor graft. Best candidates are patients with a recent proximal ACL tear and good residual tissue. Dr. Gomoll has been performing this procedure since early 2022.
Do all ligament tears need surgery?
No. Some ligaments — such as the MCL of the knee — frequently heal on their own with bracing and rehabilitation. The ACL is the ligament that most often requires reconstruction or repair, particularly in active patients who want to return to cutting and pivoting sports. Dr. Gomoll will discuss whether surgery or a non-surgical course is appropriate for your injury.
Is ACL surgery outpatient?
ACL reconstruction and BEAR repair are typically performed as outpatient arthroscopic surgery at the Hospital for Special Surgery — most patients go home the same day. The exact plan depends on the procedure, your anesthesia, and your medical history, and is confirmed before your surgery date.
When can I return to sport after ACL reconstruction?
Return to cutting and pivoting sport after ACL reconstruction is generally a 9–12 month process guided by rehabilitation milestones and strength testing rather than the calendar alone. Your individual timeline depends on the graft, any associated meniscus or cartilage work, and your progress in physical therapy. Dr. Gomoll and his team interact closely with your rehab provider to monitor your progress. Rather than relying on time from surgery alone to determine return to sports, Dr. Gomoll frequently requests a formal Return to Sports assessment, which objectively evaluates your strength and agility to determine readiness to return.
When can I drive after ACL surgery?
Many patients resume driving once they are off narcotic pain medication and can control the pedals safely — often a few weeks, and longer for surgery on the right leg or when a brace and protected weight-bearing are required. Confirm timing with Dr. Gomoll, and see our after-surgery instructions for recovery milestones.
Dr. Gomoll evaluates and treats ACL and other ligament injuries at the Hospital for Special Surgery, 523 East 72nd Street on Manhattan's Upper East Side, caring for patients across New York City, the tri-state area, and beyond. See our location and directions or request an appointment.
Medical disclaimer
This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Surgical and non-surgical orthopedic care should always be discussed with a board-certified orthopedic surgeon who has reviewed your imaging, history, and physical examination. Individual outcomes vary based on diagnosis, anatomy, comorbidities, and adherence to rehabilitation.