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 What
is an ACL reconstruction?
An ACL reconstruction is a surgical procedure
that involves removing the remains of the damaged ACL and replacing
it with another form of soft tissue, called a graft.
The graft is either autogenous, which comes from the
patient, or an allograft, which is tissue donated by
an individual at the time of death.
In both cases, a portion of the patellar tendon is commonly
used to replace the ACL. This is the tendon of the quadriceps muscles
that attaches the patella to the tibia. This is a popular choice among
surgeons because the patellar tendon is a large, strong tendon, and
bone is taken at each end with the tendon section. The bone ends are
attached to the femur and tibia, allowing for bone-to-bone healing.
The bone plugs fuse in place during healing and create the strongest
fixation possible. This technique usually heals faster than when soft
tissue is attached to bone.
Another popular graft choice incorporates strands from one of the smaller
hamstring tendons
(the semitendinosus)
the gracilis
replace the ACL. Although this graft requires soft tissue-to-bone
healing, many
surgeons prefer it because there is usually less pain associated with
the harvesting technique of the graft. Some
surgeons feel there is less chance of developing kneecap pain using the
hamstring graft versus the patellar tendon graft.
A new technique for grafting uses a portion of the quadriceps
tendon, from the quadriceps muscles. This tissue has bone
at one end and soft tissue at the other. This procedure combines some
of the advantages of the patellar tendon reconstruction
and the hamstring tendons reconstruction.
An orthopaedic surgeon will usually prefer to use a patient's own
tissue for the graft. The patient's own tissue heals faster and
more reliably than allograft tissue. In addition, allograft tissue
has a risk of disease transmission, although this risk is extremely
small.
For some patients, allograft tissue may be the better choice.
Patients who have had numerous knee surgeries may not have sufficient
tissue available for grafting. An allograft might be the best choice
for an older patient who needs the least amount of invasion of the
joint in order to heal without complications.
There are many types of devices used to secure the graft to the bone.
Some examples are interference screws, screw/ washer, endobutton,
and cross pins. Some are metallic and others are absorbed by the body
over time. The type of graft procedure the surgeon chooses will determine
the fixation technique.
ACL reconstructions are almost always done arthroscopically,
although compound injuries may require open surgery. The repair
is done with visualization by the arthroscope. One or two incisions
are made to take the graft, drill tunnels in the bone, and to position
it correctly.
ACL reconstruction can either be performed in an out-patient setting,
or as an inpatient procedure with an overnight hospital stay.
 
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