An Overview of Anterior Cruciate Ligament (ACL) Surgery

If a sport requires a lot of cutting and twisting maneuvers, then the anterior crucial ligament (ACL) is important for stabilizing the knee during the activity. Sports such as football, soccer, gymnastics, basketball, and baseball fall into this category.

In the past, surgeons have tried to so a tour in anterior cruciate ligament back together again. This is been shown not to work as there is simply not enough healing potential to finish the healing process. So with a torn anterior cruciate ligament, the standard of care is to actually replace the ligament and reconstruct it.

When it comes to replacing the anterior cruciate ligament, the graft options include either an allograft or an autograft. Autograft means using tissue from the patient's body. This would include potentially a hamstring tendon or maybe part of the patient's own patellar tendon. These tissues do not end up getting missed by the patient.

An allograft is when tissue is taken from a cadaver. This may include the patellar tendon allograft or a hamstring tendon allograft. Studies looking at these tissues have shown that both work well for ACL reconstruction and a large part of time individuals can go back to a heavy amount of athletic activity similar to before the injury.

An ACL surgery with the reconstruction replaces the tear with new tissue that is either from the patient himself or comes from a cadaver.

The anterior cruciate ligament connects the front, top part of the tibia which is commonly known as the shinbone, to the femur. Which is commonly known as the thighbone. The part of the femur that is connected is the bottom rear portion.

During the anterior cruciate ligament reconstruction, and initial incision is made vertically over the front of the knee. If part of the patient's patellar tendon is going to be used as an autograft, that is harvested at the beginning of the surgery.

Along with the piece of the patella tendon that is taken out a little bit of bone from each insertion is used from both the tibia and the kneecap. This will then be the anterior cruciate ligament replacement.

The rest of the surgery is performed through small incisions on both sides of the knee through an arthroscopic surgery camera. This allows the surgeon to see inside the knee and to make sure the new ACL is positioned correctly. With the knee bent, the damaged ligament is removed and the knee is cleaned of frayed areas from its damage.

Once the area is cleaned up nicely, the surgeon will insert a pin diagonally through the femur and tibia. This actually ends up being the guide for placing the new ACL graft. Additional holes are then drilled with the autograft being attached to the guide pin and pulled through for placement.

Once the new ACL graft is in position, special pony screws are placed in the tibia and the femur to secure it so that it would heal properly. At that point, the knee is put through a full range of motion to make sure there is no impingement of any areas of the new ACL graft.