Sports medicine surgeon Dr. Jihad Abouali covers knee anatomy, meniscus tears, ACL reconstruction vs repair, graft options, and return-to-sport timelines for athletes.
Sports Medicine & Arthroscopic Surgery
View ProfileThe knee is a hinge joint—it basically flexes and extends just like a hinge on a door. But it's actually more complex than that, with subtle rotational movements that play an important role when you're turning or twisting.
There are three main components:
The bones create the foundation, but they're supported by ligaments and tendons:
Inside the knee, you have the meniscus (shock absorbers—one on each side) and cartilage covering the bones for smooth articulation.
The knee is a weight-bearing joint and quite complex. Because there's a lot of force when we're jumping, running, and twisting, that force goes through the knee. The ligaments and tendons are susceptible to injury because of the constant force, twisting, and load on this weight-bearing joint.
Think of the meniscus like a shock absorber. It's made of collagen with a rubbery feel—like a piece of rubber between your two knee bones. It can withstand compressive forces, softens the blow when there's impact, and creates better articulation so there's not as much force going through your cartilage.
A meniscus tear usually happens from a twisting mechanism that grinds the bone into the meniscus, creating a tear or rip. Common scenarios:
When it tears, there's bleeding and joint swelling—the knee might get quite puffy.
With meniscus tears, the pain is very localized—one specific spot on the inside or outside of the knee. It doesn't radiate down the leg. We ask patients: "Can you point to your pain with one finger?" If they point along the joint line where the knee bends, that's indicative of a meniscal tear.
An MRI is needed to confirm the diagnosis and show the exact location and zone of the tear.
The meniscus has different zones with different blood supply:
Blood supply provides all the nutrients needed to heal tissue. Without it, there's no introduction of growth factors and no regenerative capacity—whether we stitch it or let the body try to heal on its own.
A repair means not removing any tissue—you're stitching it back together to preserve the meniscus's function as a shock absorber. This is only possible when the tear is in an area with good blood supply.
The procedure: Done arthroscopically through 2-3 tiny keyhole incisions. We find the tear, reduce the tissue back into place, then stitch it with specialized instruments—all minimally invasive, no large incisions.
Recovery: About 5-6 months to return to sport. We work stepwise—first range of motion, then strengthening, then dynamic activities like agility and speed work.
A partial meniscectomy removes only the damaged fragment—we preserve as much tissue as possible. The goal is to remove the "unstable fragments" that are moving around, causing pain, catching, or locking.
The procedure: Also minimally invasive through keyhole incisions. Usually faster than a repair since there's only one fragment to remove.
Recovery: Much faster at 4-6 weeks because there are no internal stitches to protect. Patients can weight-bear immediately and bend the knee even the same day.
The ACL (anterior cruciate ligament) is one of the main stabilizing ligaments of the knee. It connects your femur to your tibia and prevents the shin bone from coming too far forward or over-rotating during dynamic movements in sports.
ACL tears are actually non-contact injuries. It happens when someone's changing direction quickly in a sudden or unpredictable movement. The foot is planted and the body keeps rotating, but the foot doesn't move with it—that's what snaps the ACL.
Top 3 sports: Soccer, basketball, and skiing. All involve jumping, twisting, cutting, and pivoting. With skiing, the boot often doesn't come out of the binding, causing massive twisting force.
Note: Turf has slightly higher ACL injury rates than grass because there's less give in the surface and cleats can get stuck.
Telltale signs that warrant seeing a doctor:
The ACL is under a lot of tension naturally. When it tears (often in the middle or from the femur), it retracts backwards and has no way to reattach. Within the knee, synovial fluid washes away any blood clot that could form and mature into new tissue.
Ligaments outside the knee (like MCL) have good blood supply and no synovium washing away the blood—that's why they can heal. The ACL, bathed in synovial fluid, never gets that chance.
Reconstruction means recreating a new ligament by taking a tendon from another part of the knee (or from a donor) to replace the ACL. This is done when the remaining ACL tissue isn't good enough to repair.
Two categories: Autograft (your own tissue) or Allograft (donor tissue).
Autograft options:
Key fact: Most grafts have a higher load to failure than the original ACL. The hamstring actually has the highest tensile strength of the three.
Nothing heals in your own knee like your own tissue. Re-tear rates are lower with autograft compared to allograft, especially in younger patients. There's no chance of rejection because it's your own tissue.
When is allograft (donor tissue) used?
The surgery is the easy part—the rehab is the hard part.
Re-tear rates: For younger patients playing pivoting sports, rates range from 8-15%. Patellar tendon offers the lowest re-tear rates. Using your own tissue (autograft) has lower re-tear rates than donor tissue.
ACL repair means stitching the original ligament back together instead of replacing it with a graft. It preserves the original tissue.
Candidates: Select cases where the tear is proximal (near the femur attachment) and some ACL tissue is still attached. The MRI guides this decision.
Duration: About 1 hour—faster than reconstruction since no graft is harvested.
Because you didn't take a graft and didn't drill large holes in bone—only small suture anchors. Patients experience:
Book a consultation with Dr. Abouali or one of our sports medicine specialists. Virtual appointments available across Canada.