Anterior Cruciate Ligament (ACL) Tears: ACL Repair Using Suture and Bone Anchors

Anterior Cruciate Ligament (ACL) Tears: ACL Repair Using Suture and Bone Anchors

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.

First, a suture is passed through the top of the ACL with a suture-passing instrument that is inserted into a plastic tube called a cannula. The suture is passed through the ACL several more times in an alternating crisscross fashion, leaving 2 suture ends coming out of the top of the ACL.

The surgeon makes another skin incision, or portal, and pushes the suture material into the knee. The 2 suture ends are pulled out of the newly created skin portal to move them out of the way. The surgeon then uses a different color suture to create the same suture pattern through the rest of the ACL.

Here are the 2 sets of suture ends: blue and white. The surgeon will switch these sets of sutures for the next step so that the white sutures come out of the newly created portal and the blue sutures come back out of the cannula.

Next, the surgeon drills a tunnel through the femur, or thigh bone. This drill will be used to find the correct spot where the ACL was attached. Once the tunnel is drilled, an instrument called a tap is used to widen the start of the tunnel to create a socket.

The white sutures coming out of the extra portal will be used first. They are threaded through the end of a hard-body anchor, which is brought into the knee and inserted into the socket in the thigh bone. The ends of the white sutures are then cut off.

The same steps are repeated for the blue sutures. They are moved from the cannula to the extra portal and another socket is created in the thigh bone. The blue sutures are threaded through another anchor. This anchor has flat support sutures already attached to it that will be used to support the ACL. The anchor is inserted into the socket, and the blue sutures are cut off. The flat support sutures remain.

The surgeon checks the tension of the graft, then moves to the front of the shin and uses a special guide to drill a pin through the tibia, or shinbone. There is a small inner needle that gets removed from the pin, and a wire loop is passed up through the pin into the knee.

Once the wire loop is inside the knee, both the wire loop and flat support sutures are pulled out of the cannula. The support sutures are passed through the wire loop, which is pulled back through the cannula and through the shinbone tunnel to bring the flat support sutures out the front of the shin. Here, you can see the support sutures lying next to the ACL.

The surgeon drills a small hole in the front of the shinbone and inserts a hard-body anchor to tack down the support sutures. The end of the support 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.