Anterior Cruciate Ligament (ACL) Tears: ACL Reconstruction Using an All-Inside Soft-Tissue Graft Animation

Anterior Cruciate Ligament (ACL) Tears: ACL Reconstruction Using an All-Inside Soft-Tissue Graft Animation

This surgical animation demonstrates an all-inside ACL reconstruction using a soft-tissue graft for the treatment of an ACL tear. The graft can be made from different kinds of tissue, most commonly from a hamstring tendon or a quadriceps tendon. Each of these grafts are prepared slightly differently, but the steps in the surgery are the same.

Here, we see a right knee that is bent to expose the inside of the knee joint. First, a socket is drilled through the femur, or thigh bone. A special guide is used to make sure the drill aims at the right spot inside the knee. A drill is inserted through the guide.

Once the drill is correctly positioned inside the knee, the drill guide is removed, and the drill sleeve is tapped into the thigh bone. A tiny blade flips out of the drill inside the knee joint, and the drill is pulled back to create a socket through the thigh bone from the inside out.

A suture loop is then placed into the drilled socket and pulled out the front of the knee. It is tied out of the way for now. The same steps are repeated to make a socket in the tibia, or shinbone. The same guide is used to aim at the right spot inside the knee, and the drill is inserted through the guide.

The blade at the end of the drill flips out, and the drill is pulled back to create a socket in the shinbone from the inside out. Another suture loop is placed into the drilled socket, and both sutures are pulled out the front of the knee. Here, the blue and white suture is in the thigh bone, and the black suture is in the shinbone.

The graft has already been prepared with an adjustable suture device that contains a small metal button. The blue and white suture loop is placed around the sutures from the graft and used to pull the graft into the socket in the thigh bone. The metal button is pulled out of the socket to sit on the outside of the thigh bone.

Tension is applied to the sutures to further pull the graft into the socket. Next, the black suture loop is placed around the other end of the graft and used to pull the graft into the socket in the shinbone. The knee is straightened, and a small metal button is placed over the sutures exiting from the shinbone.

The sutures are tightened until the button sits right up against the shinbone to hold the graft and sutures in place. In some cases, a flat support suture, seen here, may be added to support the tendon graft. If this support suture is used, it is fixed to the bone with an anchor below the metal button for further support.

The sutures are tightened, and the knee is bent and straightened to check the tension of the graft. Final tension is applied, and the extra sutures are cut off. The ACL reconstruction is now complete.