ACL

RECONSTRUCTION

-NANDAN KULKARNI
MEET SHAH
LIGAMENTOUS ANATOMY OF THE
KNEE
 LIGAMENTS OF THE KNEE

CRUCIATE LIGAMENTS
 Anterior Cruciate Ligament (ACL)
 Posterior Cruciate Ligament (PCL)

COLLATERAL LIGAMENTS
 Medial Collateral Ligament (MCL)
 Lateral Collateral Ligament (LCL)
 CAUSES OF ACL INJURY

1. Changing directions rapidly

2. Stopping suddenly
3. Slowing down while running
4. Landing from a jump incorrectly
5. Direct contact or collisions such as football
tackles
 ACL injuries occur when bones of the leg
twist in opposite directions under full body
weight
 GRADE 3
Grade 3 ACL tears happen when the ACL is torn
completely in half and no longer providing any
stability to the knee joint.

 TIBIAL SPINE AVULSIONACL INJURY

Adolescents may also commonly have what is
called tibial spine avulsion ACL injury. In this
injury the ACL itself is not torn but the bony
attachment of the ligament to the tibia is pulled
of. Depending on how far the bony attachment
of the ligament is pulled off the injury can result
in weakness or instability of the knee if not fixed.
 TYPES OF ACL TEAR
 GRADE 1
Grade 1 ACL injury include ACLs that have
suffered mild damage , e.g., the ACL is
mildly stretched but still provides
adequate stability to the knee joint

 GRADE 2
Grade 2 injuries are rare and describes an
ACL that is partially torn and stretched
TREATMENT FOR AN ACL TEAR

 NON SURGICAL
Non surgical treatment is mostly required for
grade 1 injuries. This would include
immobilization or bracing, physical therapy and
a gradual progression back to regular activities
and sports
 SURGICAL
Surgical treatment is recommended for
individuals with a grade 3 tear or complete ACL
tear. Surgical options may vary based on the
type of ACL injury. ACL reconstruction surgery is
performed for such injuries.
 ACL RECONSTRUCION
 Investigations of an ACL injury can either
be done by
1. MRI
2. Arthroscopy
 MRI of the knee gives the exact location
and type of the ACL injury
 ACL tears are not usually repaired using
sutures to sew it back together cause
repaired ACLs have generally been shown to
fail over the time

 Therefore a torn ACL is generally replaced by

a substitute
GRAFT MADE OF TENDON
The grafts commonly used to replace ACLs
include

AUTOGRAFT ALLOGRAFT

 Patellar tendon  Patellar tendon

 Hamstring tendon  Achilles tendon
 Quadriceps tendon  Semitendinosus
 Gracilis or posterior
tibialis tendon
 Patients treated with surgical
reconstruction of the ACL have long
term success rates of 82%-95%

 Goal of the ACL reconstruction

surgery is to prevent instability and
restore the function of the torn
ligament, creating a stable knee
 The ACL surgery is completed by making
some tiny insertions around the knee area
of the leg.

 One insertion is made for the tiny camera

which provides the view of the joint.

 One more insertion is made to inflow a

fluid which provides transparency to get
more clearer view of the joint.
 One or two more insertions are made on
either side of the knee cap by the surgeon
to get access to the joint to perform the
reconstruction process.

 One more barely small insertions is made

to enter new graft in the place of ACL.
 To start the procedure, the surgeon will insert
a probe to inspect the damaged joint.

 Then a small motorized shaper is used to

remove the damaged ACL and to prepare the
area for the new one.

 The surgeon will also inspect the entire joint

to determine whether there is additional
damage or need other repair.
 RETRO FLIPCUTTER
POSITION OF THE RETRO FLIPCUTTER
 This tunnels will become a source for the
anchor points for the ACL grafts

 A device called retro flipcutter is used to

create a tunnel through the femur into the
knee joint.

 The surgeon will also create a tunnel

through the tibia and into the knee joint
from below.
 As discussed before the graft will be taken
from the patient’s own hamstring tendon.

 Using the patient’s own tissue reduces the

likelihood of rupturing the ACL again.

 A surgeon will harvest more hamstring than

needed to avoid the challenge of not
harvesting enough.

 Hamstring tendons consistently regenerate

over the time as well.
 The surgeon will prepare the harvested
hamstring and pull it through the upper hole
to the lower hole just hard enough to imitate
the original ACL.

 A small grappling hook will block the upper

end of the graft and the screw will stabilize
the lower end.
 The graft from the hamstring tendon will act
as a scapple upon which a new ACL will grow.

 Over the time the hamstring graft undergoes

changes and instrengthens and results in a
strong and viable ACL.