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ACL Reconstruction Procedures

Surgery to repair the anterior cruciate ligament (ACL) in the knee has come a long way since surgeons first tried to simply sew the torn ligament back together. Today, doctors have several options to repair the ACL.

  1. About the ACL

    • The ACL is the stabilizing ligament of the knee and spans from the thigh bone to the shin bone, through the center of the knee joint. A healthy ACL prevents knee instability. The ligament can be torn, usually if a person changes direction suddenly, as in athletics, or if the knee hits an object that causes it to decelerate quickly. If the ACL is completely torn, reconstruction surgery is the only way to properly repair the knee, after a period of recovery from the initial injury.

    Patellar Tendon Graft

    • In most cases, doctors will transplant a tendon or ligament from one part of the patient's body in order to replace the torn ACL. A patellar tendon graft is a popular choice, as it uses the middle third of the person's patellar tendon as a replacement. It is also called a bone-tendon-bone graft because when the patellar tendon is removed, doctors not only take the tendon, but also remove two pieces of bone on either end of the tendon. These small bones are used to help fit the new tendon into holes drilled into either side of the joint in the injured knee.

    Hamstring Graft

    • In this case, the doctor will remove a part of the patient's hamstring tendon in the same leg as the injured knee and use it as the graft for the ACL. The fixation technique is the same as doctors use in the patellar tendon procedure, except instead of tiny bones doctors use special screws inserted into the hamstring tendon to help affix the tendon to the knee. This procedure is being used in younger patients who are still growing, since the procedure doesn't damage the patient's growth plates.

    Allograft Procedure

    • You might also know this as the cadaver procedure, in which doctors use a tendon from a cadaver for the surgery. The best tendons for this transplant are patellar, hamstring and the Achilles tendon. The procedure to attach the cadaver tendon is the same as the other two ACL procedures, depending upon what is best for the patient. This procedure works well for patients who require multiple transplants.

    The Incision

    • Most ACL surgeries are done arthroscopically. To accomplish this, doctors use a pen-shaped camera inserted into the knee to allow the doctor to see the knee joint via a television screen. The doctor then uses small instruments to complete the surgical procedure. The advantages to this procedure are less surgical trauma to the knee and a shorter recovery time after surgery. In many cases, ACL surgery has turned into an outpatient procedure in which patients go home the same day.

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