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ACL knee surgery explainedArthroscopic ACL knee surgery, set-up for acl reconstruction (Image Credit: Seif Medical Graphics)

ACL surgery begins with an arthroscopic examination of the inside of your knee. In many ways, arthroscopic surgery has revolutionized the process of ACL reconstruction (and orthopedic sports medicine in general). This surgical technique uses three very small incisions that are about 1/4 of an inch in length to create "portals" into the knee. A fiber-optic light source illuminates the inside of the knee and a video camera feeds an image to a monitor so that the surgeon can see inside the knee. A sterile saline solution is continuously pumped through the knee via a cannula so that the operative field is always clear.

 

Actual arthroscopic knee surgery for acl reconstructionSurgeons watch via a video monitor
The term "arthroscopic" comes from two Greek words that mean "to look inside a joint." During arthrocsopic knee surgery, the surgeons maneuver and use their tools by watching the image (provided by the arthroscope) displayed on a video monitor.

 

acl knee surgery, torn ACL removed (Image Credit: Seif Medical Graphics)
After the surgeon inspects the knee for damage to the cartilage or the menisci, the remnants of the torn ACL are removed with a high-speed shaver. This tool is a very specialized device that is used to remove torn ligaments or torn pieces of cartilage from the knee. The surface of the intercondylar notch where the ACL normally attaches to the femur is then prepared with a high-speed burr so that the proper location for the tunnel for acl knee surgery, tunnels drilled (Image Credit: Seif Medical Graphics)femoral fixation can be seen clearly.

Tunnels are then drilled through the bone in the femur and the tibia so that the graft can be placed in the center of the knee in the same position as the original ACL. A separate incision that is about 2 to 3 inches long also has to be made in order to harvest the graft from either the patellar tendon or the hamstring tendons. After the graft has been harvested, it is then prepared by placing several very strong surgical sutures through the graft that are used to fix it in place. acl knee surgery, graph secured with screws (Image Credit: Seif Medical Graphics)Some surgeons will also braid the graft before passing it through the tunnels.

After the graft is passed through the tunnels, it is then tensioned and fixed in place. A variety of fixation techniques have been developed to anchor the graft to the bone. Different techniques are used for different types of grafts, and today, fixation failures, though possible, are very rare.

Once the graft has been fixed in place and any additional damage has been addressed, the incisions are closed and a sterile dressing is used to cover the knee. This dressing will usually stay on for several days while the wound begins to heal.

 

 

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