Anterior Cruciate Ligament (ACL) Tears: ACL Reconstruction Using a Quadriceps Tendon Graft

Anterior Cruciate Ligament (ACL) Tears: ACL Reconstruction Using a Quadriceps Tendon Graft

This cadaveric surgical video demonstrates an ACL reconstruction using a quadriceps tendon graft for the treatment of an ACL tear.

Here, we see a right knee with the inner side of the knee on the right side of the screen. The surgeon has already made small incisions, called portals, around the knee to insert the surgical instruments to perform the procedure. An instrument called an arthroscope contains a light and camera that is used to see inside the knee joint.

Here, you can see inside the knee. The surgeon has already cleared out any damaged tissue to get ready to start the procedure. First, the surgeon aligns a drill guide onto the knee to position where the first bone socket will be drilled in the femur, or thigh bone.

The surgeon drills a pin through the thigh bone from the inside of the knee and pushes the pin by hand out of the skin on the outside of the thigh. Next, a reamer is placed over the pin from inside the knee to widen the socket.

A suture loop is passed through the socket that will be used later to pull the tendon graft into the knee. Next, the surgeon aligns a drill guide onto the knee to position where the second bone socket will be drilled into the tibia, or shinbone. A small incision is made in the skin for the drill guide.

A drill is inserted through the guide into the knee. Once inside the knee, a tiny blade flips out and the drill is pulled back to create a socket. Another suture loop is passed through this socket. Both suture loops from the 2 drilled sockets are pulled out through the front of the knee. The blue suture loop is from the socket in the thigh bone while the black and white striped suture loop is from the socket in the shinbone.

Here is the prepared quadriceps tendon graft that was already harvested from the patient through a separate incision. It has already been prepared with an adjustable suture device containing a small metal button.

The blue suture loop from the thigh bone is looped around the sutures from the prepared graft and used to bring the graft into the knee.

The small metal button that is attached to the sutures will sit on the outside of the thigh bone to hold the graft in place. The metal button is pulled out of the socket first. Then, the tightening sutures are pulled to slowly bring the graft into the socket.

The black and white striped suture loop from the shinbone is looped around the sutures on the other end of the graft and used to pull it into the shinbone socket.

After checking the final position of the graft, the surgeon places a round metal button on top of the sutures exiting from the shinbone to hold the graft and sutures in place. The tensioning sutures are pulled to fully tighten the graft in place and then cut off. The surgeon tightens the sutures exiting from the thigh bone one more time before cutting them off. The skin incisions will be closed with sutures, and the ACL reconstruction is now complete.

Here is a final look at the reconstructed ACL inside the knee.