Scars After an ACL Repair

The anterior cruciate ligament, or ACL for short, is one of the four major fibrous ligaments in the human knee. Its job as a ligament is to anchor one bone to the other; in this case, it originates deep within a notch of the femur in the upper leg and attaches to the tibia in the lower leg. Injuries to the ACL will dramatically affect the ability to move and bend your knee. If rest, medication and physical therapy fail to improve the condition of the knee, then surgery might be recommended. However, scars can also develop from surgery.

Someone's knee after an ACL repair. (Image: clsgraphics/iStock/Getty Images)


An ACL injury is the most common knee ligament injury, especially in athletes. Major damage to the ACL requires reconstructive surgery. It uses tissue from your own body or from a donor to replace the ACL. With knee arthroscopy, a tiny camera is inserted into the knee through a small incision. This is done to observe the ligaments of your knee. Further incisions are made to remove the old ligament and attach a new ligament to the bones with screws or other devices.


The size of the cut depends largely upon the specifics of the surgery. If your own tissue is being used to formulate a new ACL, then your surgeon will inevitably make a larger cut through which the old tissue is removed and the "new" tissue is transferred. Tunnels must then be made in the bones to bring the new tissue through. Donor tissue, on the other hand, requires a smaller cut.


A scar is a patch of skin that grows over a wound such as that from surgery. As a natural part of the healing process, it's composed of the same protein -- known as collagen -- as the tissue that it replaces. In most cases, the scar will dissipate over time, but it is possible to develop long-lasting or permanent abnormal scars, especially if you have a history of keloids, or excessively thick scars due to an aggressive healing process, which block off the regeneration of knee tissue.


Most scars are relatively benign and mere aesthetic annoyances, but if you are concerned about a scar, consult a dermatologist for advice. Keloid scars in particular may hinder mobility; those that develop in the knee are an acute burden because the knee facilitates the movements that are central to the body. Various treatments might be applied to minimize the appearance of the scar. These include surgical revision, dermabrasion, laser treatment, injections, chemical peels and creams. Preventative measures are limited; however, a silicone gel pad can be used to prevent the complete development of keloid scars -- and even many normal scars -- that have not fully matured. Silicone gel pads encourage the tissue to soften, flatten, lighten its pigmentation and may clear away the symptoms after several months. However, the scar may continue to persist in some form.


For the most part, the appearance of a scar does not necessarily predict the results or efficacy of an operation. It merely denotes the ability of your skin to properly heal and clear away the scar tissue over time. Even those patients with enlarged scars can have excellent surgical results.

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