Home > Knee > ACL Injury > ACL Reconstruction

Overview

It is important to understand the different treatment options following an Anterior Cruciate Ligament injury.

Options include:

1. Nonoperative treatment

2. ACL Repair

3. ACL Reconstruction:

   • Autograft

   • Allograft

Some individuals who are less active can sometimes treat a torn ACL without surgery. Sewing or suturing your own native ligament back together is called an ACL Repair. Removing the torn native ligament and replacing it with a graft is called an ACL Reconstruction.

This section discusses ACL Reconstruction.

Best ACL Reconstruction Options

There are different options available to reconstruct a torn ACL. There are two main categories for reconstruction -- autograft reconstruction and allograft reconstruction.

Autograft option requires taking tendon from another area of your body and using it to replace the torn ACL. Common autograft choices include patellar tendon, hamstring tendon and quadriceps tendon.

Allograft option involves using tendon from individuals who have donated their organs and musculoskeletal tissue following death. This is sometimes referred to as a “cadaver graft.” Allograft tissue is regulated by the FDA.

Each graft choice has its strengths and weaknesses and should be discussed with your surgeon.

Prior to the start of the surgery a thorough examination of the knee is done under anesthesia. The exam is performed to confirm the presence of an ACL tear and to ensure that there are no other associated ligament injuries.

The surgery begins by entering the joint with a small camera called an arthroscope. The arthroscope allows visualization of all knee structures (menisci, ligaments, cartilage) through a very small hole, called a portal site. A second portal site is also made to introduce small instruments necessary to perform the surgery.

At this time it is determined if there are also meniscus injuries that need to be addressed.

After treatment of all other injuries, attention is turned to the ACL reconstruction. The torn ACL is removed and the knee is prepared to allow for introduction of the graft that will become the new ACL. This involves drilling bone tunnels in both the tibia and femur.

The graft is then introduced into the knee and passed into the tunnels. This will sometimes require other incisions around the knee. The graft ends are fixed into each tunnel with one of many options for fixation devices (e.g., screws, metal buttons, etc.).

The knee is again examined to confirm proper placement of the graft, the incisions are closed and a postoperative knee brace is often applied.

Postoperative Plan

Discuss with your surgeon the postoperative plan. Typically weight-bearing, range of motion exercises and formal physical therapy are encouraged soon after surgery.