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ACL Reconstruction

The Anterior Cruciate Ligament (ACL) is a ligament in the center of your knee that becomes damaged when twisted too far, such as in a skiing injury.

ACL Reconstruction is performed using a combination of open surgery and arthroscopy.

The ACL shown above is healthy and firmly attached to the femur and tibia.


To the right is a badly torn ACL which will need to be reconstructed.

Before the ACL reconstruction process begins, your surgeon will examine your knee arthroscopically, and repair any additional damage to the knee, such as a torn meniscus, or worn articular cartilage.


Reconstruction of the ACL begins with a small incision in your leg where small tunnels are drilled in the bone (left).

Next your new ACL is brought through these tunnels, and then secured. As healing occurs, the bone tunnels fill in to secure the tendon.


There are three methods of creating a replacement ACL. The first, shown right, uses the patellar tendon, which connects the patella to the tibia.

The middle third of the tendon and a small portion of bone on either end is harvested and used as the new ACL. This is called a patellar tendon autograft, because your own tissue is used.

Another autograft method uses the semitendinosus-gracilis (hamstring) tendons, which connect muscles in the back of the thigh to the lower leg. Two small portions of these tendons are harvested and removed through a small incision in your leg, then they are looped to form a strong new ACL:

The third method of creating a replacement ACL uses an allograft, meaning the tendon comes from a source other than your own body, such as a donated achilles tendon.