ACL Reconstruction- Illustrations:
About your knee... "torn ACL??"
50% of acute ACL tears are accompanied by cartilage damage, and the rate goes up if the knee is left alone and remains unstable!!
How do we fix these problems??
Top: a partial ACL tear partially torn from its femoral attachment with stretching of the ligament. This is truly unusual, as the majority of ACL tears are complete, with nothing left (see below). A dilemma: leave alone or fix??
Bottom: the problem with ACL tears- torn cartilage, in this case a displaced "bucket handle tear of the meniscus". The first step toward arthritis of the knee.
Hamstring tendon autograft is harvested from a small incision just below the patella. Alternatively, a patella tendon graft can be used.
The hamstring donor autograft tendons are prepared. They are bundled, sutured, and attached to a button device to fix them to the bone after they are passed through the tunnels in the knee.
A "notchplasty" is performed to widen the intercondylar notch, and provide more room for the new ACL graft. A narrow notch is a risk factor for ACL injury. Here it is done in three steps: removing debris and the remnant ACL stump and scar tissue, gross widening with a chisel, and fine tuning with a motorized burr.
A perfect meniscus tear for repair, a vertically-oriented tear at the periphery where blood supply is excellent and the potential for healing is high. Proper tear selection is the first pre-requisite for repair.
The meniscus is meticulously repaired throughout to anchor it to its rim, usually with permanent sutures.
Some tears cannot be repaired, and with a heavy heart, the surgeon elects partial menisectomy (removal).
After all cartilage work is complete, ACL reconstruction is completed:
top- attachment points are precisely selected for tunnel/socket placement,
middle- tibial tunnel(left) and femoral sockets (right) are prepared, drilled, and edges chamfered,
bottom- the graft after placement into the knee joint.
Top: a femoral socket is drilled to a precise depth using a special reamer device.
Middle: tunnels are measured for appropriate graft length, fixation and tension.
The state of the art technique is the "double bundle double tunnel" reconstruction, achieved only with a hamstring graft, which offers a more anatomic ACL reconstruction. (click here for an overview)
Bottom: the ACL graft is pulled into position, with the fixation button leading, which will secure the graft in the top end without the need for a large second incision and scar.
The final product: a well-placed, strong, tensioned, and secured ACL autograft, ready for rehabilitation.