Anterior Cruciate Ligament (ACL) Tears: ACL Repair Using a Suture Implant

Anterior Cruciate Ligament (ACL) Tears: ACL Repair Using a Suture Implant

This cadaveric surgical video demonstrates an ACL repair for the treatment of an ACL tear.

Here, we see a left knee with the inner side of the knee on the left side of the screen. The surgeon has already made small incisions, called portals, to pass surgical instruments in and out of the knee. Inside the knee, you can see that the ACL has torn directly off of the bone.

In order to try and give this ACL the best chance at healing, the surgeon drills small holes in the part of the femur, or thigh bone, where the ligament is going to be reattached.

Then, the surgeon aims a pin at the correct spot where the ACL was attached and drills a tunnel through the thigh bone. On the back of the pin is a little hook where the surgeon places a suture to be passed through the tunnel. There is a loop on the end of the suture that will be used to pass the repair sutures through the tunnel. For now, it is clamped on the outside of the knee and saved for later.

Next, the surgeon uses a special guide to drill a pin up through the tibia, or shinbone. The pin comes up through the base of the ACL where it attaches on the top of the shinbone inside the knee. There is a small inner needle that gets removed from the pin and a small wire loop is passed up through the pin into the knee. The wire loop is removed from inside the knee and taken out the other portal. The wire loop is also set aside and saved for later.

Here is the passing suture implant that will be used to attach an adjustable suture device to the ACL. The surgeon places the loop of the passing suture implant onto a suture-passing instrument and brings the implant into the knee. The surgeon uses the suture-passing instrument to pass the suture implant through the ACL. In this case, the surgeon has decided to use 2 passing suture implants. After they are pulled tight, they create luggage tag rings around the ACL.

The surgeon splits the sutures, so there is 1 coming out of each portal and begins with the 1 on the left. Here is when the surgeon must create the double loop of the adjustable suture device. The #1 suture from the product card is threaded through the opening in the passing suture end. The other passing suture end is pulled to pass the #1 suture into the knee through the luggage tag ring and back out.

The surgeon retrieves the suture from the other portal and repeats the same steps with the same #1 suture from the product card. Here, the white loop is going through both passing suture implants. Next, the #2 suture from the card is removed, passed through the #1 suture loop, and then back through the metal loop on the card, which is attached to the blue tab on top. The blue tab is pulled, and the #2 suture is pulled up to thread the sutures through the adjustable suture device, completing the double loop.

All of the sutures from the adjustable suture device are removed from the card. These sutures contain a small metal button that will sit outside the thigh bone and flat support sutures that can be used to support the ACL. The surgeon passes the sutures from the adjustable suture device through the looped suture that was placed in the thigh bone earlier, which is used to pass the sutures into the tunnel. The metal button is pulled out of the tunnel and flipped out to sit on the outside of the thigh bone.

The white tensioning sutures are pulled one at a time to move the ACL tissue closer to the thigh bone.

The surgeon then threads the flat support sutures through the wire loop that was placed through the shinbone and pulls the metal wire through the tunnel to pull the support sutures out of the shinbone. The surgeon then drills a small hole in the front of the shinbone and the ends of the support sutures are tacked down with a hard-body anchor.

The surgeon uses the white tensioning sutures to fully tighten the ACL. Once final tension is achieved, the sutures will be cut off and the skin incisions will be closed with additional sutures. The ACL repair is complete. Here is a final look at the repaired ACL with the support suture inside the knee.