Anterior cruciate ligament reconstruction (ACL reconstruction) is a surgical tissue graft replacement of the anterior cruciate ligament, located in the knee, to restore its function after anterior cruciate ligament injury. The torn ligament is removed from the knee before the graft is inserted through a hole created by a single hole punch. The surgery is performed arthroscopically.

The anterior cruciate ligament, or ACL, is one of four major knee ligaments. The ACL is critical to knee stability, and people who injure their ACL often complain of symptoms of their knee giving out from under them. Therefore, many patients who sustain an ACL tear opt to have surgical treatment for this injury.

Important Steps In Intraarticular ACL Reconstruction Surgery in india

Once the graft is harvested, it is passed through a tibial tunnel, through the knee joint, and through a femoral tunnel. It is usually secured at either end with compression interference screws or an alternative fixation device. Surgery is now facilitated by the use of jigs, which allow arthroscopic reconstruction.

Thorough examination of the knee under anaesthetic particularly to pick up associated instabilities that may lead to premature failure of the reconstruction.

• Diagnostic arthroscopy to examine the menisci and joint surfaces.
• Meniscal repair or excision
• ACL stump excision

Lateral superior expansion notch-plasty — expanding the femoral notch to allow accurate graft placement and free motion

Placement of an appropriately sized tibial tunnel (based on the size of the graft). It should be in the posterior third of the ACL tibial footprint. If the tibial tunnel is positioned anteriorly, extension is restricted and graft impingement may cause early rupture or loss of knee extension.

Placement of appropriately sized femoral tunnel. It should be at 11 o’clock in the right knee and 1 o’clock in the left knee at the back of the intercondylar notch when viewed arthroscopically. If the femoral tunnel is positioned anteriorly, flexion is restricted which may cause a loss of motion or graft failure due to stretching.

Secure fixation of the graft in both tunnels, usually using interference screws, although there are more and more fixation devices available. These are usually left in permanently.

How Is The ACL Repaired?

There are a number of different techniques available to repair a torn ACL. Each surgeon has his preference for each particular situation.

In fact we don’t talk about ACL “repair” but rather about ACL “reconstruction.” This is because a torn ACL cannot simply be repaired by sewing it together again. This was the method tried in the early days of repairing ACL tears, but it was shown to be ineffective. Thus, newer methods were developed which involve reconstructing the ACL ligament, including substituting a new ligament for the damaged one. Using tendons from other parts of the body as a substitute for the ACL was found to be the most effective way of reconstructing the torn ACL. Currently, the two most popular methods in use are using part of the patella tendon or using a hamstring muscle tendon.

Today ACL reconstruction is essentially an arthroscopic procedure, though many surgeons throughout the world still prefer to open the knee. If this route is chosen, depending on how the ACL is repaired, then the incisions may not be very different from those done arthroscopically.