Once a ligament is torn, it does not repair or heal itself. Normal strength and durability do not return without reconstruction of the ligament and that requires a tendon graft to replace the ruptured tendon.
There are many different ways to reconstruct the damaged ligament. For the anterior cruciate ligament inside the knee, there are two main choices: the patellar tendon graft that you had and the alternate: hamstring tendon graft.
There are pros and cons to each one of these. Neither one is perfect yet. Attaching the graft in place (called fixation) creates problems of its own. In particular, finding a place to attach the hamstring tendon graft to the bone is a challenge. That’s one reason why surgeons choose the patellar tendon over the hamstring tendon for the graft. It’s also one reason why they are looking for ways to do the reconstruction procedure that yield better results with fewer problems and a lower failure rate.
Other treatment approaches that have fewer limitations and fewer adverse effects are under investigation. For example, scientists are exploring tissue engineering, the use of growth factors, bone morphogenetic protein (BMP), and other types of cells in ACL reconstructive surgery.
The use of donor grafts from animals known as xenografts (e.g., from calf skin or calf small intestine) is one area of intense study. But these are not readily available as yet. Efforts to develop an artificial ligament (also referred to as a ligament-augmentation device) have not been successful as yet either. Such a system could help patients heal and rehab faster but may not be as strong or as resilient as natural tissue.
There may be some things that can be done about the appearance of your scar. Although it will fade over time, application of vitamin E oil is recommended by some to soften the scar tissue. A physical therapist trained in techniques such as myofascial release can also assist in keeping the scar and surrounding soft tissues flexible. Preventing scarring from binding the tissue and causing puckering can also aid in movement and appearance.
The stiffness may resolve over time but should be re-evaluated by your surgeon. This may be something that can be addressed by your physical therapist as well. Don’t hesitate to make a follow-up visit with your surgeon to review both of your concerns.