Anterior Cruciate Ligament (ACL) Tears: ACL Reconstruction With Biologics Animation

Anterior Cruciate Ligament (ACL) Tears: ACL Reconstruction With Biologics Animation

This animation demonstrates an ACL reconstruction with biologics. Biologics are products made from living cells that can be used to support surgical procedures. In this ACL reconstruction, a paste-like mixture made from bone graft from a donor and blood components and tiny pieces of bone from the patient is used to support the new ACL that is reconstructed from a tendon graft.

Here, we see a right knee that is bent to expose the inside of the knee joint. The damaged ACL has already been removed. First, bone marrow is removed from the front of the shinbone. This bone marrow is spun at a high speed to separate out specific blood components that will be used later. A special guide is used to align a drill at the correct angle at the end of the thigh bone, or femur, where a tunnel will be made. A drill pin is inserted into the guide to drill through the bone.

As the blade at the end of the drill flips out and is pulled back to widen the tunnel, a shaver connected to a suction system and collecting chamber is used to collect tiny pieces of drilled bone. A tunnel will also be made in the shinbone, or tibia, in a similar way. The tiny bone pieces are removed from the collecting chamber and transferred to a dish with bone graft from a donor. The blood components taken earlier from the patient are added and mixed together to make a paste-like mixture.

Here is the prepared tendon graft that will be used to reconstruct the ACL. The graft has an adjustable suture device with a small metal button attached at one end that will sit on the outside of the thigh bone. A flat support suture will also be used during this procedure to support the graft. The sutures attached to the graft are pulled into the thigh bone, and the metal button is flipped to sit on the outside.

Before the graft is pulled into the knee, both drilled tunnels are filled with the paste-like mixture to try to create an environment that can improve the ability of the graft to heal to the bone. The graft is pulled into the tunnel in the thigh bone first, and then into the tunnel in the shinbone. The paste-like mixture compresses around the tendon graft to help create a better fit inside the tunnels. The knee is straightened, and a second metal button is placed over the sutures exiting the shinbone to tighten the graft and flat support suture. A hard-body anchor is also placed over the flat support suture to further hold it in place.