Cruciate - ACL surgery

• CRUCIATE LIGAMENT SECTION
• intro
• anatomy
• issues
• key points
• how ACL is injured
• how PCL is injured
• ACL diagnosis
• PCL diagnosis
• multi-ligament instability
• braces - types
• braces - issues
• surgery intro
• ACL surgery
• PCL surgery
• rehab
• complications

The surgical procedure for a torn ACL is usually a reconstruction using graft material.

Some surgeons do attempt to repair an ACL that has just ruptured (i.e. 'primary repair' - sewing the ends together), but this is not common practice. Usually a ligament replacement procedure ('reconstruction' or 'graft') is performed (i.e. cutting out the old ligament and putting in a replacement).

There are currently a number of types of procedure, each with different good and bad points and different indications, but in practice most knee surgeons will concentrate on getting good at one technique and stick to it.

It is possible to use strong synthetic material to replace the ligament, and also possible to use animal tendon or cadaver (human donor = 'allograft'). But in general tendon material is taken from the patient's own body ('autograft'), usually from the same knee as the injury and the body does a pretty good job of repairing the donor site.

The first choice is usually one or the other of -

• BPTB - bone-patellar tendon-bone autograft
  (also called PTG - patellar tendon graft)
• Hamstrings - four-strand semitendinosus/semimembranosus autograft

In general, most patients in competent hands get good results. But there can be complications (see the section on complications).