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ACL Reconstruction / Knee Reconstruction

OVERVIEW

ACL reconstruction is a safe and effective operation to get you back on your feet again, keeping fit and enjoying the sports you love.

ACL reconstruction surgery involves taking a tendon graft from one part of your body and inserting it into your knee to function as an ACL.  There are various tissues that are routinely used for ACL Grafts, there are pros and cons of each, but options are:

  • Hamstring Tendons (Gracilis and Semi-Tendinosus Tendons)
  • Patella Tendon
  • Quadriceps Tendon
  • Cadaver Tendons
  • Synthetic Tendons

Dr Slattery has used many different types of grafts, and different types of grafts suit different patients.  For routine reconstructions he prefers using Hamstrings Grafts due to a very low rate of complications, excellent strength, and terrific long term results.

Over time, the hamstring tendons regenerate. (See Image at Right)

 

 

Procedure

Anaesthetic

The surgery is typically performed under general anaesthetic with the use of local anaesthetic blocks and infiltration to reduce the need for opiates and strong pain relief which can slow down recovery.  This can be discussed with your anaesthetist prior to your operation.

Incisions

Dr Slattery performs Arthroscopic ACL reconstructive Surgery.  This means that he only need to utilise small keyhole incisions to reconstruct your ACL.  There are two other small incisions that are needed to harvest the tendon graft, and to secure the graft in place. These are closed with dissolving stitches to reduce discomfort and scarring.

 

Above: Pen indicates regenerated Hamstrings tendon

Technique

The knee is thoroughly inspected by knee arthroscopy initially to assess for associated knee injuries, such as meniscal tears which can occur in up to 60% of patients.  These may require treatment at the same time as ACL reconstruction.

The ACL is assessed and the knee is prepared for reconstruction.  Two bone tunnels are drilled in the femur and the tibia in an anatomic location to accept the new graft.  Tunnel placement is critical for graft survival and ACL function.

The graft is then passed through the tunnels and secured with fixation in the tibia and femur to allow the graft to integrate.  There are various types of fixation available and each have advantages and disadvantages, common techniques are buttons, screws and staples.  These are normally visible on post operative X rays.

 

Associated Procedures

In some cases it may be necessary to do other ligament reconstruction procedures to give the knee additional stability, an example of this would be an anterolateral ligament reconstruction (ALL).  This has increased in popularity recently to control rotation in high demand and heavier patients.  This requires an additional incision and involves taking a strip of tissue from the outside of the knee (ITB) to recreate the anterolateral ligament.

If there is an associated meniscal tear, this may require repair at the time of ACL recontruction, and additional incisions may be required depending upon the type of tear and its location.

Above: bone tunnels for ACL reconstruction shown by blue arrows
Above: Knee reconstruction with Graft passed and secured with button fixation.
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