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

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

The following surgical demonstration shows an all-inside ACL reconstruction on a left cadaver knee. This particular video shows a hamstring graft being used. In this left knee, 2 small incisions have already been made in the front of the knee to view inside the joint and to perform the surgery.

This special drill guide is used so that the surgeon can drill from the outside in on the thigh bone, or femur, hitting the location inside the knee where the new graft will be placed. A small incision is placed on the outside of the knee to give the drill pin a path down to the bone. Once the drill pin is inside the knee, a small blade is exposed so that the surgeon can drill the tunnel or socket from the inside out. A long suture is placed down the tunnel and removed from the front of the knee. This will be used to bring the graft into the new socket.

Using the same drill guide, a similar bone socket will be created in the shin bone, or tibia. Just like the incision made on the side of the knee, a small incision is made on the front of the shin for the drill. Once the bone socket is made, a different color suture will be used to bring the graft into the tibia to make sure the graft is placed correctly. The surgeon then brings both of the sutures out of the knee to pass or shuttle the graft into the joint.

The end of the graft going into the femur is passed first. There is a metal button with the sutures that sits on the outside of the bone to hold the graft in place. You can see here the button passing through the socket to the outside of the bone. There is a set of sutures that get pulled one at a time to slowly pull the graft into the socket. Once the graft is in the bone socket, the surgeon then uses the other suture to pass the end of the graft that is going into the tibia. Here, the graft is seated in both sockets.

Next, a second metal button is placed on the sutures that are going through the tibia. In some cases, the surgeon may decide to use an extra suture to help support the graft while it is healing. This suture is placed through the button as well. The button is tightened down to the bone with another set of pulling sutures. The surgeon will use a suture anchor to fix the extra blue suture down to the bone. Here is the final look.