ACL reconstruction

Alternative Names: Anterior cruciate ligament repair

ACL reconstruction is surgery to rebuild the ligament in the center of your knee with a new ligament. The anterior cruciate ligament (ACL) keeps your shin bone (tibia) in place. A tear of this ligament can cause your knee to give way during physical activity.

Description of Procedure

You will probably receive general anesthesia right before surgery. This means you will be asleep and pain-free. Sometimes, other kinds of anesthesia are used for this surgery.

The tissue that will replace your damaged ACL will come from your own body or from a donor. A donor is a person who has died and, before death, chose to give all or part of his or her body to help others.

• Tissue taken from your own body is called an autograft. The two most common places to take tissue from are the knee cap tendon or the hamstring tendon. Your hamstring is the muscle behind your knee.
• Tissue taken from a donor is called an allograft.

The procedure is usually done by knee arthroscopy. With arthroscopy, a tiny camera is inserted into the knee through a small surgical cut. The camera is connected to a video monitor in the operating room. Your surgeon will use the camera to check the ligaments and other tissues of your knee.

Your surgeon will make other small cuts around your knee and insert other medical instruments. Your surgeon will fix any other damage found, and then will replace your ACL by following these steps:

• The torn ligament will be removed with a shaver or other instruments.
• If your own tissue is being used to make your new ACL, your surgeon will make a larger cut. Then, your surgeon will remove this tissue through the larger cut.
• Your surgeon will make tunnels in your bone to bring the new tissue through. This new tissue will be in the same place as your old ACL.
• Your surgeon will attach the new ligament to the bone with screws or other devices to hold it in place. As it heals, the bone tunnels fill in. This secures the new ligament.

At the end of the surgery, your surgeon will close your cuts with sutures (stitches) and put a dressing on them. Most surgeons take pictures during the procedure from the video monitor so that afterward you can see what was found and what was done.

Risks of ACL reconstruction

The risks from any anesthesia are:

• Allergic reactions to medicines
• Breathing problems

The risks from any surgery are:

• Bleeding
• Infection

Other risks from this surgery are:

• Blood clot in the leg
• Failure of the ligament to heal
• Failure of the surgery to relieve symptoms
• Injury to a nearby blood vessel
• Pain in the knee
• Stiffness of the knee or lost range of motion
• Weakness of the knee

Review Date: 6/4/2011
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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