Surgical Technique For ACL Reconstruction

Once the diagnosis confirms the rupture/failure of ACL, the surgeon proceeds to treat the patient. As the ACL cannot be repaired, the only option to treat the patients suffering from this disorder is to replace this ligament. The basis of selection of replacement graft is as discussed in the chapter dealing with Anatomy and disorders of the Knee. Today, the surgeon has a wide choice of grafts to select from:

1. Bone-Tendon-Bone (Patellar Tendon) Graft
2. Soft Tissue (Hamstring, Semi-T/Gracilis) Graft
3. Allograft
4. Artificial Ligament

As discussed earlier, though Patellar tendon is a popular graft for ACL/PCL, it has two distinct disadvantages, viz. Weakened Patella making it prone to fractures and affected Patellar tracking causing Patello-Femoral pain. Use of Semi Tendinosus ligament takes care of both these problems. Allografts are grafts taken from other individuals. This is required in multiple ligament tears as in case of trauma. But these grafts suffer from the disadvantage of possible transmission of infection/diseases. Finally, attempts have been made to make artificial ligaments but have shown very less strength. Because of this, artificial ligaments have not gained that wide an acceptance so far. In present circumstances, Hamstring graft is gaining maximum popularity and acceptance. A quadrupled soft tissue graft suits the needs of ACL just fine. Semi Tendinosus graft is not preferred only if the LCL and/or MCL are not in order.