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 at the right is healthy and firmly attached to the femur and tibia.
To the right is a badly torn ACL, which would 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 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 at the 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 and are looped to form a strong new ACL.
The third method of creating a replacement ACL uses an allograft. This is different than an autograft because the tendon comes from a source other than your own body, such as a donated Achilles tendon.