Anterior cruciate ligament (ACL) repair or reconstruction is a procedure designed to restore stability to the knee after a ligament tear, most commonly caused by sports injuries or sudden twisting movements. The process typically begins with an orthopedic evaluation that includes a detailed medical history, physical examination, and imaging such as MRI to confirm the extent of ligament damage and assess associated injuries to the meniscus or cartilage. In some cases, especially when swelling and stiffness are present, patients may begin physical therapy before surgery to restore range of motion and reduce inflammation, which can improve surgical outcomes. When surgery is recommended, the procedure is usually performed arthroscopically, using small incisions and a camera to guide the repair. In most cases, the damaged ACL is not stitched back together but reconstructed using a tendon graft, which may come from the patient’s own body or from a donor. The surgery is typically done on an outpatient basis under regional or general anesthesia. After the graft is placed and secured, the knee is stabilized and the incisions are closed. Recovery is a structured, multi-phase process. Immediately after surgery, patients focus on pain control, swelling reduction, and safe movement, often using crutches and a brace for support. Physical therapy begins early and progresses over several months, emphasizing gradual restoration of motion, strength, balance, and knee stability. As healing continues, therapy becomes more sport- or activity-specific, especially for patients aiming to return to athletics. Full recovery and return to high-impact activities often take six to nine months or longer, depending on individual factors and adherence to rehabilitation. ACL repair is not only about fixing the ligament itself, but about guiding patients through evaluation, surgery, and rehabilitation to safely regain knee function, confidence, and long-term joint health.