Anterior Cruciate Ligament (ACL) Reconstruction
Long graft is taken from the middle section of the patella tendon involving a plug of bone from lower part of the knee cap and piece of bone from the upper tibia. The deflated patella tendon is closed. The tendon heals and regains its strength.
ACL reconstruction surgery is continued with the help of the arthroscopy which allows the inside view of the knee on a monitor.
A guide pin is passed through the upper tibia which helps to create a tunnel in the proper location in the tibia. It enters the joint at the spot where the ACL normally attaches to the tibia. The guide pin is over drilled with cannulated drill, allowing it to pass through the tibia tunnel and into the femur. It is drilled into the bone at the spot where ACL normally attaches to the femur. The pin is over drilled to the appropriate depth. A long guide pin is now passed upward through the tibial tunnel across the joint into the femoral tunnel and out through the front of the thigh. This guide pin is used to pull the ACL graft through the tibial tunnel across the joint and into the femoral tunnel. The knee is fully flexed. A guide pin is pushed through a small opening in front of the knee in to the femoral tunnel next to the graft and interference screw is passed over the pin and screwed into the femoral tunnel to secure the upper end of the graft in the femoral tunnel. The knee is now extended and the graft is pulled tightly. A second interference screw is screwed into the tibial tunnel to lock into place the lower end of the graft within the tibial tunnel. The screws hold the new ACL in place until the bone plugs healed. The knee is now stable and motion can begin immediately. In fact a continuous passive motion machine is used to slowly move the knee about 23 hours a day. This early and continuous motion is very important to decrease knee pain, to quickly regain knee motion and to avoid problems with the knee cap.