Types of ACL Surgery: Different Techniques and Graft Options Explained

The ACL tear can lead to the loss of knee stability, so the ACL surgery is a way of restoring it. The procedure mostly used is ACL reconstruction surgery where the damaged ACL is replaced with autogenetic/biological or allogeneic tendon tissue. The choice of surgery also depends upon the severity and pattern of injury, patient’s age, occupation, level of sports participation and any associated ligaments injuries or not.

1. Arthroscopic ACL Reconstruction

Out of any ACL operation today, this kind of arthroscopic ACL reconstruction one is the most frequently done one. It is a least invasive technique that employs a small camera with a light (arthroscope) and special instruments put in through microincisions.

A torn ACL is generally substituted by a tendon tissue graft through this method and the tissue will behave like an original ligament.

Likes of arthroscopic ACL surgery include:

• Lesser cuts needed
• Lower pain and swelling
• Early recovery
• Less visible scars
• Improved intra-knee joint visibility

2. Single-Bundle ACL Reconstruction

Single-bundle ACL reconstruction is considered standard and is frequently performed.

It has these features:

• One graft is used only to replace the ruptured ACL
• This reconstruction provides forward stability of knee
• This method of surgery is well-taken by patients who have suffered isolated ACL tears

Advantages:

• Reliable knee joint stabilization
• Short operation time
• Positive long-term outcomes

3. Double-Bundle ACL Reconstruction

Double-bundle ACL reconstruction is supposed to replicate and preserve the two functional parts of ACL.

ACL itself has the following two major bundles：

• Anteromedial bundle
• Posterolateral bundle

Bone-to-bone fixation of knee joint with the use of double graft bundles will result in greater rotational stability of the joint.

In which situations this method could be applied?

• Individuals playing pivoting sport who need more knee joint rotational stabilization
• People whose activities are high in demands, like those working long hours or doing intensive work
• Selected cases of complicated ACL tear where both ACL bundles are affected

4. ACL Reconstruction Using Hamstring Tendon Graft

The hamstring tendon graft is one of the primary graft options in ACL reconstruction.

After harvesting a portion of the hamstring and other tissues, the surgeon will reshape them to form the new ACL.

Advantages:

• Limited discomfort on the anterior side of the knee
• Smallest incision is possible
• Secure and dependable graft
• Patient satisfaction in rehabilitation outcomes

Patellar Tendon graft is one method where a small part of a patient’s patellar tendon is taken together with pieces of patella and a part of shinbone. Sometimes, this is simply referred to as the BPTB (Bone-Patellar Tendon-Bone) graft.

Hamstring Tendon graft is another widely preferred option, but both procedures have their pros and cons and can depend mostly on what type of athlete and what expectations you are dealing with.

5. Patellar Tendon Graft (ACL Reconstruction Using a Bone-Tendon-Bone Graft)

The graft obtained from the patellar tendon (the tendon that connects the patella to the tibia, or the shin bone) can also be called the bone-patellar tendon-bone (BPTB) graft.

Possible concerns:

• Anterosuperior knee pain is possible
• Aching or discomfort when kneeling

Advantages:

• No need to harvest tissues from the donor
• A short time for processing the graft
• No pain at the site of the graft harvesting

6. Quadriceps Tendon Graft for ACL Reconstruction

This ACL grafting technique involves taking the quadriceps tendon from above the kneecap. This graft offers a good strength and a good healing capacity. Hence it has become a very popular option nowadays.

Benefits:

• Wide availability of donor tissue
• High-quality ligament
• Better preservation of the hamstrings
• Graft suitable for revision surgery

7. Allograft ACL Reconstruction (Donor Tissue)

One way of obtaining the tendon for reconstruction is to take the allograft, which refers to a graft from a donor.

However, for the selected group of patients who may have very few options, it could be the last resort for such patients and a great advantage would be no pain at the site of harvest. It is the reason that, in some patients who may have limited activity or who are elderly, this is the main consideration.

8. ACL Revision Surgery

In most cases of a failed ACL graft, doctors might recommend that you undergo ACL revision surgery (otherwise known as revision ACL reconstruction).

The doctor might explain the various reasons why this happened as for the graft failure, these may include:

Revision surgery is usually complicated and demands the highest possible level of attention both by the patient as well as the surgeon. Thus, the planning and execution should be very thorough.

9. ACL Repair (Not for the Major Tear Cases)

ACL surgery in general involves the removal of the ligament and then a reconstruction of it with a graft. However, for select cases ACL repairs is one of the more recent options available.

It is when the surgeon is trying to fix theACL, leaving theACL intact rather than replacing it, the technique is ACL repair surgery.

In particular ACL repair could be the best option or at least suitable if theACL injury is not very severe (i. e. no/very little tear but just some ligament stretching), and theACL is not completely separated from its bone attachment.

Which Type of ACL Surgery Is Best?

Different people have the same surgery, yet they come out with different results. Therefore, choosing a surgery for an ACL injury depends on several factors. These include:

• The nature and position of the ACL injury
• Age of the patient

Sports and activities one engages in Keep the knee joint stable before surgeries

elter injuries

A qualified knee surgery expert reviews all these things to determine which ACL procedure to use.

Your Guide about Different Types of ACL Surgery

1. How does ACL surgery most frequently take place?

ACL operation via arthroscopy by putting a graft into a tendon is the most frequently performed procedure. This kind of ACL operation gives a very good level of kneejoint stability and quicker healing than conventional large operation.

2. Which graft is the most recommended for ACL reconstruction?

There is no absolute perfect graft for a person. All three types of grafts, namely, the hamstring, the patellar tendon, and the quadriceps tendon, can lead to an ideal outcome. Which graft to go for depends upon a number of factors such as patient’s age, activity level, and surgeon’s opinion.

3. Is a reconstruction the only procedure for ACL injury?

ACL injury mostly requires a reconstruction surgery because the fully torn ACL tendon can’t get back naturally. On the other hand, ACL repair is another option for the patients with specific type of tear but with a very limited number.

4. Do you know what a single-bubble ACL surgery and a double-bubble one mean?5. What type of ACL repair is suitable for athletes?

Athletes are likely to opt for an ACL surgery that is durable and gives maximum knee stability. Patellar tendon, hamstring autograft, or quadriceps tendon allograft may be considered, based on the sport, the age, and the surgeon’s evaluation.

6. What should I do if my ACL surgeon has made a mess?

It definitely is possible. One of the main approaches after a failed ACL operation is a repeat ACL operation. It’s important however, to figure out why your initial ACL repair failed so you and your doctor can tailor your care in the best possible way.