You are here

Anterior cruciate ligament reconstruction

Totally torn cruciate ligaments do not successfully repair themselves.

Partially torn cruciates may repair themselves successfully, but a surgeons may choose to 'augment' a partially torn ligament with a graft so that the patient does not go on to a total tear and secondary damage to other structures.

Early surgical procedures (eg. MacIntosh) relied on strengthening the supports on the outside of the joint (extra-articular repair). A surgical breakthrough was made in the late 1970s with the introduction of synthetic ligament replacements, which led to the development of surgical techniques and instrumentation for internal reconstruction (intra-articular reconstruction).

Intra-articular reconstruction is now mainstream, with the 'hamstrings autograft' or the 'bone-patellar tendon-bone' autograft being the standard procedures. An autograft uses material (usually tendon) from another part of the patient's body for the graft material.

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).

Updated: 17 Apr, 2013
ABOUT THE AUTHOR

Dr Sheila Strover

Clinical Editor
Degrees: 
BSc (Hons)
MB BCh
MBA

Dr Sheila Strover is the founder of the KNEEguru website. Although not a knee surgeon, she has a sound understanding of knee surgery and...

0 Comment(s) to the "Anterior cruciate ligament reconstruction"

Advertisement

joinus

Advertisement


  • Latest
  • Blogs
  • Popular
  • Tags
Because the patella is an integral part of the whole muscle-tendon-bone structure that extends the...
Saturday, September 13, 2014 - 5:57pm
This is a clinical test for laxity of the anterior cruciate ligament. The patient lies on his/her b...
Saturday, September 13, 2014 - 10:44am
Fifty years ago, Dr. Hughston, one of the founding fathers of American Sports Medicine, imparted a...
Wednesday, August 20, 2014 - 11:51pm
In this paper, I have gathered together several papers and discussions about patellar instability f...
Wednesday, July 9, 2014 - 1:37pm
So, i stumbled upon this site a few weeks ago and i have got to say, you are all awesome! any and every...
Monday, September 22, 2014 - 7:46pm
Total knee replacement represents a considerable insult to the system when you consider - the patient...
Saturday, June 21, 2014 - 11:25am
I had a total hip replacement  two weeks ago today, hip and incision are great, but my femoral nerve has not...
Tuesday, June 3, 2014 - 3:54pm
Some time ago at a medical educational meeting about high tibial osteotomy, I was chatting to a...
Saturday, May 24, 2014 - 11:39am
The back of the knee is called the 'popliteal' region of the knee. The depression in the middle of...
Sunday, June 29, 2008 - 9:43am
    Mr Wilson qualified from St Bartholomew’s Medical school in 1994. He carried out his specialis...
Thursday, June 30, 2011 - 9:11pm
All the well-recognised exercises and stretches for full knee rehabilitation, with photographs and...
Wednesday, March 26, 2008 - 7:38pm
This course by Frank Noyes MD covers the issue of why an anterior cruciate ligament (ACL) reconstru...
Thursday, October 25, 2007 - 4:08pm
-A A +A

Word of the Day

A response to a clinical test performed by the doctor, which gives an idea about diagnosis of the problem.

User login