Illnesses & Conditions
Information on diseases and health concerns, including symptoms, treatment options, and prevention.

Anterior cruciate ligament (ACL) surgery

Surgery Overview

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 autografts 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.
• 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 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.

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 doctor 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.

Surgical drills are inserted through other small incisions. The surgeon drills small holes into the upper and lower leg bones where these bones come close together at the knee joint. The holes form tunnels through which the graft will be anchored.

The surgeon will take the autograft (replacement tissue) at this point. If it comes from the knee, it will include two small pieces of bone called "bone blocks" on the ends of the tissue. One piece of bone is taken from the kneecap and the other piece is taken from a part of the lower leg bone near the knee joint. If the autograft comes from the hamstring, bone blocks are not taken. The graft may also be taken from a deceased donor (allograft).

See a picture of a bone and tissue graft .

The graft is pulled through the two tunnels that were drilled in the upper and lower leg bones. The surgeon secures the graft with screws or staples and will close the incisions with stitches or tape. The knee is bandaged, and you are taken to the recovery room for 2 to 3 hours.

During ACL surgery, the surgeon may repair other injured parts of the knee as well, such as ligaments, cartilage, or broken bones.

© 1995-2009, Healthwise, Incorporated, P.O. Box 1989, Boise, ID 83701. ALL RIGHTS RESERVED.