Knee · Sports medicine

ACL reconstruction in Canada

ACL reconstruction is performed arthroscopically with 4K visualization by our fellowship-trained sports medicine surgeons. Graft options include All-Inside, bone-patellar-tendon-bone (BTB), and quad tendon techniques, matched to your activity level and anatomy. Consultations in 1–3 days, with surgery typically 2–4 weeks later. Return to running averages 4–6 months; return to pivoting sports is typically 9–12 months, guided by return-to-sport testing.

At Pathway, our fellowship-trained knee surgeons perform ACL reconstruction. Consultations are available in 1–3 days, with surgery typically 2–4 weeks later.

Book a consultation (647) 799-3230
  • Outpatient — most patients home same day
  • Multiple graft options
  • Surgery in 2–4 weeks
  • No referral required
Patient cycling along a coastal route after ACL reconstruction recovery
5.0 from 250+ reviews
Return-to-sport testing

At a glance

ACL reconstruction at a glance

ACL reconstruction is performed arthroscopically with 4K visualization by our fellowship-trained sports medicine surgeons.

1–3 days
to first consultation
2–4 weeks
from consult to surgery
Same day
most patients home, outpatient
9–12 months
typical return to pivoting sport
Patient stories

Recovery, in their words.

5.0 from 250+ patient reviews

Both our boys suffered simultaneous knee injuries from contact sports. They had to undergo ACL reconstruction and meniscectomy. The Pathway team was very helpful and attentive from A to Z. The whole team was a pleasure to work with.

Marie Emond

ACL reconstruction & meniscectomy

I had an amazing experience with Dr. Jihad Abouali for my ACL reconstruction. The entire process was smooth, professional, and stress-free. Dr. Abouali’s expertise and precision made the surgery seamless, and my recovery has been going exactly as expected.

Realtor Elango

ACL reconstruction

I had ACL reconstruction by Dr. Thierry Pauyo. He is incredibly skilled in knee surgeries and sports medicine. What impressed me most is his up-to-date medical knowledge. Joseph and Mike from Pathway were helpful, professional, and quick to respond.

Sasan Arbabzadeh

ACL reconstruction

Read more patient stories
The procedure

What is ACL reconstruction?

The anterior cruciate ligament (ACL) is one of the key ligaments that stabilizes your knee joint. When torn — often during sports involving sudden stops, pivoting, or jumping — the ACL cannot heal on its own in most cases.

ACL reconstruction replaces the torn ligament with a tissue graft, which acts as a scaffold for a new ligament to grow. The procedure is performed arthroscopically through small incisions, allowing your surgeon to see inside the knee using a camera while specialized instruments create tunnels and secure the graft.

At Pathway, our surgeons offer multiple graft options and techniques tailored to your anatomy, activity level, and goals — from recreational athletes to professionals.

Surgeon insights

Hear from our surgeons.

Our sports medicine specialists discuss ACL injuries, graft options, and the road to recovery.

Q&A guide

Knee sports injuries Q&A

ACL reconstruction techniques, meniscus treatment, and return-to-sport timelines.

Full Q&A guide
Technique demo

See the All-Inside technique

Watch how the bone-preserving All-Inside ACL technique works.

Full Q&A guide
View all surgeon Q&A guides
Surgical technology

4K arthroscopic visualization.

Crystal-clear imaging for precision surgery.

Both of our ACL surgeons use 4K imaging technology from Smith+Nephew to visualize the knee anatomy with exceptional clarity during surgery.

  • 4x the resolution of standard HD arthroscopy
  • Enhanced tissue differentiation for identifying structures
  • Photo documentation — see exactly what was repaired post-op

After your surgery, your surgeon can show you high-resolution images of exactly what was done inside your knee.

4K Imaging System

4K Imaging System

Ultra-high-definition visualization that allows surgeons to see fine anatomical details with unprecedented clarity.

Technology by Smith+Nephew

Techniques

ACL reconstruction techniques.

Our surgeons offer multiple approaches tailored to your specific needs.

Dr. Jihad Abouali

Dr. Jihad Abouali

All-Inside & BTB specialist

Dr. Abouali is one of the highest volume All-Inside ACL surgeons in Canada. This technique uses smaller sockets instead of full tunnels, preserving bone stock. BTB grafts are secured with resorbable screws that integrate and become like bone over time.

  • FlipCutter 3 from Arthrex
  • Bone-preserving socket fixation
BTB graft with resorbable screws

BTB graft with resorbable screws

Dr. Thierry Pauyo

Dr. Thierry Pauyo

Quad tendon ACL specialist

Dr. Pauyo is a specialist in Quad ACL reconstruction, harvesting the quadriceps tendon for a strong, reliable graft. Suspensory fixation using ULTRABUTTON QUAD provides secure graft attachment with excellent biomechanical properties.

  • QUAD-TRAC harvesting system from Smith+Nephew
  • Very strong graft tissue
ULTRABUTTON QUAD suspensory fixation

ULTRABUTTON QUAD suspensory fixation

Graft options

Choosing the right graft.

Your surgeon will recommend the best graft type based on your anatomy and goals.

Quadriceps tendon (Quad)

Strong, thick graft harvested from above the kneecap. Growing in popularity for its biomechanical properties.

  • Very strong graft
  • Less anterior knee pain
  • Large graft diameter available

Bone-patellar tendon-bone (BTB)

Classic graft with bone plugs on each end for bone-to-bone healing. Often preferred for high-level athletes.

  • Bone-to-bone healing
  • Well-established track record
  • Excellent for pivoting sports

Hamstring tendon

Tendons from the inner thigh bundled to create the graft. Smaller incision and less anterior knee pain.

  • Smaller harvest incision
  • Less kneeling discomfort
  • Good for recreational athletes
Your surgeons

Our ACL reconstruction specialists.

High-volume sports medicine surgeons with specialized ACL expertise.

Dr. Jihad Abouali, ACL surgeon

Dr. Jihad Abouali

Knee & shoulder sports medicine

200+ ACL reconstructions per year. All-Inside & BTB specialist.
Dr. Thierry Pauyo, ACL surgeon

Dr. Thierry Pauyo

Hip, knee & shoulder sports medicine

Quad ACL specialist. Official surgeon for the Montreal Canadiens.
Read full surgeon profiles
Your recovery

Your recovery journey.

  1. 1

    Week 1

    Rest & protect

    Brace, crutches, pain management

  2. 2

    Weeks 2–6

    Early rehab

    Range of motion, quad activation

  3. 3

    Months 3–6

    Strengthening

    Progressive exercises, light jogging

  4. 4

    Months 9–12

    Return to sport

    Sport-specific training, clearance

4–6 weeks

Off crutches

Walking without assistance

3–4 months

Light jogging

With PT clearance

9–12 months

Full sports return

After passing return-to-sport testing

Could you be a candidate for ACL repair?

For certain tear types — particularly proximal tears where the ligament has pulled off the bone — ACL repair may preserve your native ligament without needing a graft. Dr. Abouali is one of Canada’s leading ACL repair specialists.

Learn about ACL repair
FAQ

Frequently asked questions.

The best graft depends on your activity level, anatomy, sport, and personal factors. Your surgeon will discuss the pros and cons of each option during your consultation and make a recommendation tailored to your goals.

The All-Inside technique creates sockets instead of full tunnels in the bone, preserving more bone stock. This can be beneficial if revision surgery is ever needed in the future and may result in less post-operative pain.

Most athletes return to sport between 9-12 months after surgery. This timeline allows the graft to fully incorporate and mature. Return-to-sport testing helps ensure you're ready before resuming competitive play.

Yes, ACL reconstruction is typically performed as an outpatient procedure. Most patients go home the same day with crutches, a brace, and pain management instructions.

No referral is required. You can book a consultation directly. Having a recent MRI is helpful but not mandatory—we can arrange imaging if needed.

Next step

Start your care journey.

Schedule a consultation to discuss your ACL injury and treatment options with one of our specialists. No referral required.

Book a consultation (647) 799-3230
Related links

Continue your research.

Specialty Knee procedures Surgeon Dr. Sebastian Rodriguez Elizalde Surgeon Dr. Michael Zywiel Surgeon Dr. Jihad Abouali Surgeon Dr. Thierry Pauyo Related procedure ACL Repair in Canada Related procedure Robotic Knee Replacement in Canada