Arthroscopic ACL Reconstruction Technique using Patellar Tendon Autograft (Diagrams and Images)

 

The anterior cruciate ligament (ACL) is a ligament inside the knee which prevent the tibia (shin bone) from sliding too far forward on the femur (thigh bone).  Here is what the ligament looks like in a cadaver.  This ligament can sometimes be torn.  Using the patient's own patellar tendon (autograft), the ligament can be reconstructed to allow the patient to return to their sport or job.

  
 

Step 1:  The patellar tendon graft is harvested through a 3 inch incision made in the front of the knee.  A small piece of the patella (knee cap), a third of the patellar tendon and a small piece of the tibia (shin bone) are carefully removed from the knee. 

 

  

 
 

Step 2:  Once the graft is removed, it is shaped into a plug as shown below to replace the old torn ligament

 

  

 
 

Step 3: Using an arthroscope (a small camera) and a shaver, the old torn ACL is removed

 

  

 

  
Using the arthroscope, the ACL appears to be torn from the thigh bone insertion  
 

Step 4:  Using a specialized burr, more room is created in the thigh bone for the new ACL

 

  

 
 

Step 5:  An ACL drill guide is used to make a precise drill tunnel in the shin bone.  This tunnel will house one of the two sides of the harvested graft.  The small images below depict how Dr. Bach makes sure the tunnel is in the anatomic position.

 

  

The gold colored guide places the shin bone tunnel in the anatomic position

  
 

Step 6:  A specialized aimer is used to create the drill tunnel in the thigh bone.  This tunnel will house the other side of the harvested graft.  Both tunnels measure about 10mm in diameter.

 

  

The tunnel in the thigh bone is being drilled

  

             

Careful inspection of the thigh bone tunnel  
 

Step 7:  At this point, the harvested graft is pushed through the shin bone tunnel into the knee and all the way up into the thigh bone tunnel.

 

  

A metallic grabber is used to help pull the graft into the knee joint

  

     

The metallic grabber pushes the graft into the thigh bone tunnel  
 

Step 8:  The thigh bone plug is secured using a metallic screw.  This screw wedges the bone plug against the thigh bone and prevents it from moving.

 

  

The metallic screw is being inserted into the thigh bone tunnel

  

Metallic screw is in place securing one side of the graft  
 

Below are two more views of the thigh bone screw being inserted.

  

 
 

Step 10:  Finally, the same process is repeated to place another metallic screw into the shin bone to secure the other side of the graft.

 

The final appearance of the graft prior to closure

 

  
 

Step 11:  The incision is washed thoroughly with sterile saline and the skin and deep tissue are closed with sutures.