Diagnosed With an ACL Tear? Getting a Second Opinion in Dallas

If another doctor has told you that you have a torn ACL, the next decision is who repairs it and how. A second opinion with Dr. Brett Raynor is a full new-patient visit: he examines the knee himself, reviews your MRI with you image by image, and walks through every option, starting with doing nothing. Sometimes the answer is that the plan you already have is the right one. Sometimes it is a different graft, a different plan for the meniscus, or no surgery at all. Bring your MRI and you will leave with a clear recommendation and the reasons behind it.

Dr. Raynor is a fellowship-trained orthopaedic sports medicine surgeon at Texas Orthopaedic Associates in Dallas. ACL reconstruction is a primary focus of his practice and the operation he performs most often; he is one of the highest-volume ACL surgeons in Dallas, and second opinions are a routine part of that practice.

Call (214) 265-3211, schedule online, or send an appointment request and note that you already have an MRI showing an ACL tear.

Why a second opinion is worth it for an ACL tear

An ACL tear is not an emergency, which is exactly why it is worth getting right. The decisions made at this visit are hard to undo later:

Whether you need surgery at all. Once an ACL tears it typically does not heal on its own, and most active people do not like the way the knee gives way with cutting, pivoting and twisting. But not every tear needs a reconstruction. Older patients and patients whose activities do not involve pivoting sports can do well without one, and Dr. Raynor will tell you if you are one of them.

Which graft. The new ligament can be made from your own patellar tendon, your own quadriceps tendon, or donor tissue (an allograft). This choice matters most in younger, more active patients. In the MOON cohort of 2,488 ACL reconstructions, the odds of tearing the new graft were 5.2 times higher with an allograft than with a patellar tendon autograft, and the odds rose with younger age and higher activity level (Kaeding et al., American Journal of Sports Medicine, 2015). In patients 18 and under, a meta-analysis of 2,299 reconstructions found graft failure in 11.8% of hamstring grafts, 7.9% of patellar tendon grafts and 2.7% of quadriceps tendon grafts (Petit et al., Orthopaedic Journal of Sports Medicine, 2024). Twenty-year data from Australia found that 39% of adolescents with a hamstring graft eventually re-tore it (Salmon et al., American Journal of Sports Medicine, 2018). Dr. Raynor's default for athletes under 20 is the patellar tendon autograft, with the quadriceps tendon as an equally sound choice, and he generally reserves donor grafts for patients over 40.

What happens to your meniscus. Nearly half of ACL tears come with a meniscus tear: 47% of patients in the Norwegian knee ligament registry had one at the time of reconstruction (Granan et al., American Journal of Sports Medicine, 2009). Trimming out the torn piece is faster and easier than repairing it, for the patient and for the surgeon, but repair is the right call far more often than it gets made, and it is the decision with the longest-term consequences for the knee. Dr. Raynor repairs meniscus tears whenever the tissue allows it, and he will tell you before surgery what he expects to find and how a repair would change your first six weeks.

Who does it. Experience with this specific operation matters. In a review of 70,547 ACL reconstructions in New York State, patients treated by lower-volume surgeons were more likely to be readmitted and more likely to need another knee operation within a year (Lyman et al., Journal of Bone and Joint Surgery, 2009). Dr. Raynor is one of the highest-volume ACL surgeons in Dallas: ACL reconstruction is the operation he performs most often, every week of the year, and his practice includes revisions of reconstructions done elsewhere.

What the visit involves

Dr. Raynor examines your knee before he looks at your pictures. He compares the injured knee with the other one so you can feel the difference yourself, then he walks through the MRI with you: the menisci, the cartilage, the other ligaments, and the ACL. He will point out the bone bruise pattern that tells him an ACL is torn even before he looks at the ligament, and, just as important, what is intact.

Then the options, in order. In his words from clinic:

"Option one is just do nothing, ignore it, and live with it. Always an option. I love doing surgery, but only if we have to. We're going to make it prove it needs it before we're going to do it."

If reconstruction is the right call, you will hear exactly how he would do it, which graft he recommends for you and why, what he plans for the meniscus, and when. If it is not, you will hear that too.

Timing: there is no rush, and that is not the same as waiting forever

The operation itself is the same whether it happens in three weeks or three months. What changes with time is the rest of the knee. A knee without a working ACL can give way, and each of those episodes can tear a meniscus or damage cartilage. In the Norwegian knee ligament registry, the odds of a cartilage injury at the time of surgery rose by about 1% for every month between injury and reconstruction, and a meniscus tear roughly doubled the odds of a cartilage injury (Granan et al., American Journal of Sports Medicine, 2009). Waiting is fine as long as you are not cutting, pivoting and twisting on the knee while you wait.

There is also such a thing as too soon. A freshly injured knee is swollen and stiff, and surgery is, as Dr. Raynor puts it, "another injury that you're just allowing me to do to you." He usually wants two to three weeks for the knee to calm down and regain motion, and he sends patients to a session or two of physical therapy first: it gets the knee ready, and you meet the therapist you will be spending the next several months with.

How Dr. Raynor performs ACL reconstruction

Through two small portals he removes the torn ligament, drills a tunnel in the femur and one in the tibia where the ACL belongs, and fixes the new graft in place. It is an outpatient surgery. You are walking on the leg right away in a brace (a meniscus repair can change how you bear weight in the first six weeks), jogging at about three months, and back to cutting and pivoting sports at seven to nine months. Waiting until nine months before returning to sport matters: in the Delaware-Oslo cohort, re-injury risk fell by 51% for every month that return was delayed up to nine months, and athletes who passed strength and hop testing before returning had a 5.6% re-injury rate against 38.2% for those who did not (Grindem et al., British Journal of Sports Medicine, 2016).

You can watch the whole operation, narrated by Dr. Raynor, in his step-by-step animations: ACL reconstruction with a patellar tendon graft and ACL reconstruction with a quadriceps tendon graft. For the full description of the surgery, see ACL Reconstruction Surgery in Dallas, and for the week-by-week recovery, the ACL reconstruction recovery roadmap.

What to bring

  • Your MRI images, not just the report. A disc from the imaging center or a link to the images is what Dr. Raynor needs; the written report alone is not enough. If the scan is more than a few months old or was done on a low-field scanner, he may order a new one.

  • Any X-rays, if you have them. He will take his own if needed, including a side view to measure the slope of the tibia, which affects the risk of re-tear and sometimes the surgical plan.

  • Operative notes from any previous knee surgery, especially a previous ACL reconstruction.

  • Your calendar. Season dates, travel, school and work commitments all go into the timing decision.

  • Your questions, written down.

Questions worth asking any ACL surgeon

Dr. Raynor would rather you ask these of everyone you see, including him:

  1. How many ACL reconstructions do you perform a year?

  2. Which graft would you use for me, and why that one for someone my age and activity level?

  3. If my meniscus is torn, will you repair it or remove it, and how would I know afterward?

  4. What is your plan if you find something unexpected once you are inside the knee?

  5. When would I return to my sport, and what tests do I have to pass first?

  6. Who guides my rehabilitation, and how closely do you work with them?

If a previous ACL reconstruction has failed

Dr. Raynor performs revision ACL reconstruction, including single-stage reconstruction with augmentation to lower the chance of another tear, and bone grafting when the old tunnels need it. A second opinion after a failed reconstruction starts with understanding why the first one failed: the graft that was used, the position of the tunnels, the slope of the tibia, and what happened to the meniscus.

Patients traveling to Dallas

Patients come to Dr. Raynor from outside Dallas-Fort Worth for ACL reconstruction. His team can coordinate the visit, imaging and surgery around your travel. Plan to stay in Dallas for at least two weeks after surgery, sometimes up to six depending on what is done, and physical therapy afterward can be done close to home.

  • You do not need one, but it is reasonable to want one. An ACL reconstruction is an operation you want done once, correctly, and the graft and meniscus decisions made at the first visit shape the knee for decades. A second opinion is most valuable if you are under 25, if you play a pivoting sport, if your meniscus is also torn, if you have been told you need a donor graft, or if the first plan did not come with reasons you understood.

  • Usually, yes. Bring the images themselves. If the scan is old, incomplete, or does not show what he needs to plan surgery, he will order a new one.

  • Use the online appointment request and mention that you have an MRI showing an ACL tear; those requests come directly to Dr. Raynor. You can also call the office at (214) 265-3211 or schedule online.

  • No. Nothing about the knee changes in the time it takes to get another opinion, and a good surgeon will not be offended that you got one.

  • Not by itself. The risk comes from the knee giving way during the wait, which is why Dr. Raynor asks patients to stay out of cutting and pivoting activities until the knee is reconstructed. Several weeks of waiting for the knee to calm down is expected; months of pivoting on an unstable knee is what raises the chance of meniscus and cartilage damage.

  • Dr. Raynor will explain exactly where and why he disagrees, and what the evidence says. The decision stays yours. His goal is that you understand the options well enough to choose, whichever surgeon you choose.

    1. Kaeding CC, et al. Risk Factors and Predictors of Subsequent ACL Injury in Either Knee After ACL Reconstruction: Prospective Analysis of 2488 Primary ACL Reconstructions From the MOON Cohort. Am J Sports Med. 2015;43(7):1583-1590. https://doi.org/10.1177/0363546515578836 (allograft 5.2x odds of graft retear vs BTB autograft; younger age and higher activity raise the odds)

    2. Petit CB, et al. Graft Failure in Pediatric Patients After BPTB, Hamstring, or Quadriceps Tendon Autograft ACLR: Systematic Review and Meta-analysis. Orthop J Sports Med. 2024;12(11). https://doi.org/10.1177/23259671241289140 (hamstring 11.8%, BPTB 7.9%, quad 2.7%)

    3. Salmon LJ, et al. 20-Year Outcomes of ACL Reconstruction With Hamstring Tendon Autograft: The Catastrophic Effect of Age and Posterior Tibial Slope. Am J Sports Med. 2018;46(3):531-543. https://doi.org/10.1177/0363546517741497 (adolescent graft survival 61% at 20 years)

    4. Lyman S, et al. Epidemiology of anterior cruciate ligament reconstruction: trends, readmissions, and subsequent knee surgery. J Bone Joint Surg Am. 2009;91(10):2321-2328. https://doi.org/10.2106/JBJS.H.00539 (70,547 reconstructions; lower-volume surgeon predicted readmission and subsequent knee surgery)

    5. Granan LP, et al. Timing of anterior cruciate ligament reconstructive surgery and risk of cartilage lesions and meniscal tears: Norwegian National Knee Ligament Registry. Am J Sports Med. 2009;37(5):955-961. https://doi.org/10.1177/0363546508330136 (odds of a cartilage lesion up ~1% per month of delay; one lesion raises the odds of the other 1.6 to 2.0x)

    6. Grindem H, et al. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50(13):804-808. https://doi.org/10.1136/bjsports-2016-096031 (reinjury down 51% per month of delay to 9 months; 5.6% vs 38.2% by RTS criteria)

Why patients choose Dr. Raynor for ACL reconstruction

Dr. Raynor completed his orthopaedic surgery residency at Vanderbilt and his sports medicine fellowship at the Steadman Philippon Research Institute in Vail, Colorado, where complex knee ligament surgery is the daily work. He is board-certified in orthopaedic surgery, a D Magazine Best Doctor every year since 2019, a team physician for the U.S. Ski and Snowboard Team, and the team physician for Highland Park High School, St. Mark's School of Texas, Ursuline Academy and The Hockaday School, which means ACL tears in athletes are a weekly part of his practice, from the sideline to the operating room to return to play. He lectures on knee ligament surgery at the Vail International Complex Knee Symposium, teaches arthroscopy at AANA Masters Courses, and has reviewed for the American Journal of Sports Medicine since 2016.

How to get a second opinion from Dr. Raynor

  • Call (214) 265-3211.

  • Schedule online through self-scheduling.

  • Send an appointment request and note that you have been diagnosed with an ACL tear. These requests come directly to Dr. Raynor.

Office: Texas Orthopaedic Associates, a Division of OrthoLoneStar, 7115 Greenville Avenue, Suite 310, Dallas, TX 75231.

Medically reviewed by M. Brett Raynor, M.D., board-certified orthopaedic sports medicine surgeon. Updated October 2026.

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