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 is 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 correct position inside the knee, and the drill is inserted through the guide.

Once the drill is correctly positioned, the drill guide is removed and the drill sleeve is tapped into the thigh bone. A small 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, where it is tied out of the way. The same steps are repeated to create a socket in the tibia, or shinbone, using the same guide to aim at the correct position.

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 this 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 graft sutures and used to pull the graft into the socket in the thigh bone. The metal button is pulled through the socket and flipped to rest on the outside of the thigh bone.

Tension is applied to the sutures to further seat the graft in the thigh bone socket. Next, the black suture loop is placed around the opposite 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 the shinbone.

The sutures are tightened until the button rests securely against the shinbone to hold the graft in place. In some cases, an additional flat support suture may be added to provide extra stability. If used, this support suture is fixed to the bone with an anchor below the metal button.

The knee is then bent and straightened to check graft tension. Final tension is applied, excess sutures are trimmed, and the ACL reconstruction is complete.