Surgery for anterior cruciate ligament (ACL) injuries involves reconstructing or repairing the ACL.
ACL reconstruction surgery uses a graft to replace the ligament. The most common grafts are auto grafts using part of your own body, such as the tendon of the kneecap (patellar tendon) or one of the hamstring tendons. Other good choices include allograft tissue, which is donor material. In repair surgery, the ends of the torn ligament are sewn back together.Most ACL surgery is done by reconstructing the ACL because reconstruction gives better results than repair surgery. Repair surgery generally is only used in the case of an avulsion fracture (a separation of the ligament and a piece of the bone from the rest of the bone). In this case, the bone fragment connected to the ACL is reattached to the bone.
ACL surgery is done by making small incisions in the knee and inserting instruments for surgery through these incisions (arthroscopic surgery) or by cutting a large incision in the knee (open surgery).ACL surgeries are usually done by orthopedic surgeons.
Arthroscopic surgery
Many orthopedic surgeons use arthroscopic surgery rather than open surgery for ACL injuries because:
It is easy to see and work on the knee structures. It uses smaller incisions than open surgery. It can be done at the same time as diagnostic arthroscopy (using arthroscopy to determine the injury or damage to the knee). It may have fewer risks than open surgery. Rehabilitation is often faster after arthroscopy than after open surgery.Arthroscopic surgery is performed under spinal or general anesthesia.
During arthroscopic ACL reconstruction, the surgeon makes several small incisions-usually two or three-around the knee. Sterile saline (salt) solution is pumped into the knee through one incision to expand it and to wash blood from the area. This allows the health professional to see the knee structures more clearly.
The surgeon inserts an arthroscope into one of the other incisions. A camera at the end of the arthroscope transmits pictures from inside the knee to a TV monitor in the operating room.
