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Types of ACL Repair

The ACL is a ligament of the knee that is crucial to its stability, and a tear often requires surgical procedures called grafts. Grafts are performed by replacing the damaged ACL with muscle tissue from another part of the body or a donor. Currently, 80 to 90 percent of those who undergo ACL repair surgery have improved knee function, reduced pain and can return to performing common activities in their lives.

  1. Patellar Tendon Grafts

    • Currently, the patellar tendon graft, also known as the bone-tendon-bone graft, is the most common form of ACL graft. This form of ACL surgery utilizes the middle third of the patella tendon. The patella tendon is a band of muscle tissue that stretches from the front of the tibia, or shin bone, to the kneecap or patella. Two minor incisions are made on each side of the patellar tendon to allow the insertion of tiny cameras called arthroscopes that assist the surgeon's visibility. Another small incision is made over the front of the knee to allow the middle tendon to be removed, along with two pieces of bone on each end. Two holes are drilled into the bones on each side of the joint where the damaged ACL is located, and are then filled with the graft. The graft is then secured into place using bioabsorbable screws that dissolve into the bone over time.

    Hamstring Reconstruction

    • The procedure for performing hamstring grafts is similar to the procedure for patellar tendon grafts. However, in this type of ACL reconstruction, strips of tissue from the patient's hamstring tendons, called the semitendinosus (back of thigh) and gracilis (top layer), are removed from the hamstring and attached together to form the graft. After the damaged ligament is removed, the bone tunnels that housed the ACL are slightly widened. Holes are then drilled into the tibia and femur bones of the leg to accept the placement of the graft. Screws or staples are used to fix the new ACL into place.

    Allografts

    • When tissue from the patient is unavailable, physicians may suggest the use of tissue from a deceased donor in an allograft. This tissue can be from the cadaver's patellar tendon, hamstring, or Achilles tendon. Repair of the ACL with this technique follows the same procedure as in patellar and hamstring reconstructions. The tendon tissue is surgically removed from the appropriate region. Holes are then drilled into the injured joint to allow the removal of the torn ACL and allow the placement of the graft tissue.

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