ACL Surgery, Surgical repair of the knees
What is the ACL?
The anterior cruciate ligament (ACL) is one of a pair of ligaments in the center of the knee joint that form a cross, and this is where the name "cruciate" comes from. There is both an anterior and a posterior cruciate ligament (PCL). Both of these ligaments function to stabilize your knee from front-to-back.
In medical terms, the ACL is the primary restraint to anterior displacement of the tibia on the femur. Translation in plain English, that when the ACL is injured or torn the shinbone can then slide forward on the thighbone, causing the knee to become unstable and “give way”.
ACL surgery begins with an arthroscopic examination of the inside of your knee. Arthroscopic surgery has revolutionized the process of ACL reconstruction (and orthopedic sports medicine in general). This surgical technique uses three very small incisions that are about 1/4 of an inch in length to create viewing access into the knee. A fiber-optic light source lights the inside of the knee and a video camera sends an image to a monitor so that the surgeon can see inside the knee. A sterile saline solution is continuously pumped through the knee so that the surgeons vision field is always clear.
During arthroscopic knee surgery, the surgeons maneuver their tools by watching the image (provided by the arthroscope) displayed on a video monitor.
Your surgeon will inspect the knee for damage to the cartilage or the menisci, the remnants of the torn ACL are removed with a shaver. This tool is a special device that is used to remove torn ligaments or torn pieces of cartilage from the knee. The surface of the intercondylar notch where the ACL normally attaches to the femur is then prepared with a high-speed burr so that the proper location for the tunnel. Tunnels are then drilled through the bone in the femur and the tibia so that the graft can be placed in the center of the knee in the same position as the original ACL.
A separate incision that is about 2 to 3 inches long also has to be made in order to harvest the graft from either the patellar tendon or the hamstring tendons. After the graft has been harvested, it is then prepared by placing several very strong surgical sutures through the graft that are used to fix it in place.
After the graft is passed through the tunnels, it is then tightened and fixed into place. A variety of fixation techniques have been developed to anchor the graft to the bone. Different techniques are used for different types of grafts, and today, fixation failures, though possible, are very rare.
Once the graft has been fixed in place and any additional damage has been addressed, the incisions are closed and a sterile dressing is used to cover the knee.
This dressing will remain on for several days.