Knee · Ligament preservation

ACL repair in Canada

ACL repair is a ligament-preserving approach for select proximal ACL tears, using Arthrex SwiveLock™ technology to reattach the native ligament instead of harvesting a graft. Consultations with our fellowship-trained sports medicine surgeons in 1–3 days, with surgery typically 2–4 weeks later. Return to pivoting sports is typically 9–12 months, following return-to-sport testing. Not all ACL tears are repairable — your surgeon will assess candidacy on MRI.

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

Book a consultation (647) 799-3230

Preserves your native ACL
Candidacy assessed on MRI
Surgery in 2–4 weeks
No referral required

Patient cycling outdoors after ACL repair recovery

5.0 from 250+ reviews

Ligament-preserving

At a glance

ACL repair is a ligament-preserving approach for select proximal ACL tears, using Arthrex SwiveLock™ technology to reattach the native ligament instead of harvesting a graft.

Preserves your native ACL
Candidacy assessed on MRI
Surgery in 2–4 weeks
No referral required

1–3 days

to first consultation

2–4 weeks

from consult to surgery

9–12 months

typical return to pivoting sport

No referral

required to start

Patient stories

Recovery, in their words.

5.0 from 250+ patient reviews

Dr. Pauyo is the best of the best when it comes to helping young athletes. Our 16-year-old son’s ACL & Meniscus surgery went even better than anticipated. His physiotherapist is continually impressed with Dr. Pauyo’s work.

Chantal Secours

ACL & meniscus repair

My 18 year old daughter had her knee blown out playing rugby. Dr. Pauyo did a quad graft ACL repair, meniscus repair and LET. Her healing is going very well — no complications. Dr. Pauyo was knowledgeable and easy to talk to.

Judith Carter

ACL, meniscus & LET

I underwent both meniscus and ACL repair with Dr. Abouali, and the process was exceptional. Traveling from Ottawa to Montreal, we were uncertain, but it was perfect. They even sent crutches before surgery and coordinated my medication delivery. I highly recommend this clinic.

Sean Kozak

ACL & meniscus repair

What is ACL repair?

ACL repair is a ligament-preserving surgery that stitches your torn ACL back together and reattaches it to the bone, rather than removing it and replacing it with a graft.

The procedure is performed arthroscopically through small incisions. Your surgeon uses high-strength sutures to repair the torn ligament, then secures it to the bone using a special anchor. This allows your native ACL to heal in its anatomic position.

Key benefits of ACL repair

No graft harvesting
No bone tunnel drilling
Preserves proprioception
Less invasive overall

ACL repair is only suitable for certain tear types — primarily proximal tears where the ligament has pulled away from the femur. Your surgeon will evaluate your MRI to determine if you’re a candidate.

Surgeon insights

Hear from our surgeons.

Our sports medicine specialists discuss ACL injuries, repair vs. reconstruction, and recovery.

Q&A guide

Knee sports injuries Q&A

ACL injuries, when repair may be possible, and the full recovery journey for athletes.

Full Q&A guide

View all surgeon Q&A guides

Surgical technique

SwiveLock ACL repair.

Advanced anchor technology for ligament preservation.

Instead of removing your ACL, harvesting a graft, and drilling tunnels, the SwiveLock technique allows us to preserve your native ligament:

1

Stitch the ACL

The torn ligament is carefully sutured together using high-strength suture material
2

Reattach to bone

The repaired ligament is secured to the tibia using a SwiveLock anchor
3

Healing begins

Your native ACL heals in its anatomic position, preserving natural knee mechanics

SwiveLock Anchor System

The SwiveLock provides secure, knotless fixation that allows the repaired ACL to heal in its natural position while maintaining tension throughout the healing process.

Technology by Arthrex

Your surgeon

Our ACL repair specialist.

Fellowship-trained in ligament preservation and sports medicine.

Dr. Jihad Abouali

Knee & shoulder sports medicine · UofT Associate Professor

Dr. Abouali is a leader in Canada for ACL repair, with specialized training in ligament preservation techniques including training with Dr. DiFelice in New York. He trains fellows from around the world in ACL repair using the SwiveLock technique.

Specialized training in ACL repair techniques
Leader in Canada for ACL repair technique
200+ ACL procedures per year
Head Physician, Scarborough Shooting Stars (CEBL)

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Candidacy

Am I a candidate for ACL repair?

ACL repair is suitable for specific tear types and patient profiles.

Good candidates

Proximal tears (near the femur)
Fresh injuries (within weeks)
Good tissue quality on MRI
Ligament has pulled off the bone

May need reconstruction

Mid-substance tears
Chronic injuries (months old)
Poor tissue quality
Complete shredding of ligament

Not sure which approach is right for you? Book a consultation and a surgeon will review your MRI.

Not a candidate for repair?

ACL reconstruction is an excellent alternative with proven long-term success. It’s suitable for all tear types and offers multiple graft options including BTB, quad tendon, and hamstring.

Learn about ACL reconstruction

FAQ

Frequently asked questions.

Neither is universally "better"—they're different tools for different situations. ACL repair preserves your native ligament but is only suitable for specific tear types. Reconstruction works for almost all tears and has decades of proven outcomes. Your surgeon will recommend the best option for your specific injury.

Recovery timelines are similar to reconstruction—most patients return to sport between 9-12 months. The early rehab may be slightly different since you're protecting the healing native tissue rather than a graft, but the overall timeline is comparable.

If an ACL repair doesn't heal successfully, you can still undergo ACL reconstruction. Since repair doesn't involve drilling large bone tunnels, it doesn't compromise future reconstruction options. This is one of the advantages of trying repair first in appropriate candidates.

No referral is required. You can book a consultation directly with our surgical team. Having a recent MRI is highly recommended to determine if your specific injury is suitable for repair.

Preserving the native ACL is intended to maintain the natural mechanoreceptors and nerve endings within the ligament, which help provide the brain with feedback about the knee's position (proprioception). It also simplifies future surgeries if ever needed, as there are no large tunnels or graft harvest sites.

Suitability for repair depends on the tear's location and the quality of the remaining tissue. Proximal tears, where the ligament has peeled away from its upper attachment point, are excellent candidates. During your consultation, we will review your MRI imaging to provide a personalized assessment.

Next step

Start your care journey.

Schedule a consultation with Dr. Abouali to discuss whether your tear is suitable for ligament preservation. No referral required.