The Knee
Reconstruction (ACL) Tear
Arthroscopic A.C.L. Reconstruction does not attempt to repair the torn A.C.L. This surgical procedure recreates the function and stability of the A.C.L. by utilizing other similar pieces of human tissue as a substitute. Currently the most common tissue used to reconstruct the A.C.L. is the middle one third of the patellar tendon.
This tissue is typically harvested from the patient's affected knee and is referred to as a patellar tendon Allograft. This piece of patellar tendon can also be harvested from a cadaver, and is processed using strict criteria to insure compatibility with the patient. Other sources of tissue include the hamstrings, quadriceps tendon, and the Achilles tendon.
After a suitable graft has been obtained, the procedure starts with a knee arthroscopy to confirm the diagnosis of a torn A.C.L. Any problems related to the meniscus are treated as indicated. A metal guide pin is carefully placed into the tibia and femur to guide a cannulated drill bit. This drill will bore holes in the tibia and femur in a location that mimics the insertion of the native A.C.L.
The graft is then pulled through the tibia into the femur using sutures that are attached to the graft. When the graft is properly positioned into the tibia and the femur, it is then secured into place with a screw, which will hold the graft firmly in position until the graft heals. The blood supply from the tunnels drilled into the tibia and the femur will promote this healing. When completely healed, the graft will be 2 to 3 times as strong as the native A.C.L. The screws are usually not painful and only occasionally require removal later.
These surgical procedures are typically done on an outpatient basis, which means that the patient normally does not need to spend the night in the hospital. Several weeks of physical therapy will be required after surgery.