Surgery involves reconstructing the ligament itself. The surgeon does this through the use of grafts, meaning that they take another tendon and fashion it into a ligament. There are a variety of graft choices. Surgeons can take a tendon from the patient or from a donor. The two most common tendon grafts are either the patellar tendon or a tendon from the hamstring. The patellar tendon has the advantages of increased strength and better fixation to the bone. However, it may cause some more knee pain if taken from the patient. Using the hamstring causes less knee pain, can be very strong, but theoretically has slower fixation than the patellar tendon. Lastly, the surgeon can use a tendon from a donor. The advantage of the donor tendon is simply that using a donor avoids taking a tendon from the patient. The patient then does not experience the pain associated with using their own tendon. However, a donor tendon may integrate slower than a tendon taken from a patient. There is also the risk of infections from the donor.
Often there will be other co-existing injuries. Any injury to the meniscus, cartilage or other ligaments will be addressed at the time of surgery.