Methods of surgery to repair the ACL in the early days involved repairing the ligament or using a synthetic material to replace the ligament. High failure rates led doctors to try new types of treatments. This led to today’s most widely used treatment, which involves a tendon graft. There are many types of tendon grafts that can be used in ACL reconstruction surgery.
Tendon Grafts
A tendon graft is a piece of tendon taken from a donor or donor site in the body that is used to reconstruct a damaged tendon. This method is much more effective for long-term results in restoring the damaged tendon, such as a torn ACL, rather than temporarily repairing the tendon. Tendon grafts are one of the most common forms of ACL reconstruction.
Patellar tendon autograft
Often recommended for patients who have a lifestyle that’s high in physical demand, the middle third of the patellar tendon is removed from the patient, along with a bone plug from the shin. Autografts have a better success rate when taken from the Patellar tendon. Knee laxity tests have also shown better results when this type of graft is used. This type of autograft can, however, cause some pain behind the kneecap as well as pain with kneeling and stiffness in the knee.
Hamstring tendon autograft
The hamstring tendon autograft for ACL reconstruction is created by the tendon on the inner side of the knee, creating a two or four strand tendon graft. With fewer risks in the graft harvesting process, the benefits of this type of graft include less stiffness, a faster recovery time, and a smaller incision. There are, however, some post-operative risks for this procedure.
Quadriceps tendon autograft
The quadriceps tendon autograft is often used for patients who have previously had an unsuccessful ACL reconstruction surgery. The middle third of the patient’s quadriceps tendon and a bone plug from the upper end of the knee cap are used in this type of graft. This gives a larger graft for those patients who are taller and heavier. Because there is a bone plug on one side only, the attachment of the graft is not as sturdy as the patellar tendon graft. There is a chance of knee pain and a risk of fracture to the patella in this procedure. The incision is also sizable.
Allografts
Allografts are grafts taken from cadavers and are currently more widely-used. These grafts are used for patients who have had unsuccessful ACL reconstruction previously. They can also be used to repair or reconstruct more than one knee ligament. The advantages of using allograft tissue include less pain, decreased surgery time, and a smaller incision. Allografts do carry some risks with them. There is a risk of infection and increased stretching of the ligament once it’s in place.
Arthroscopy
Arthroscopy is a minimally-invasive procedure in which an orthopedic surgeon makes a small incision in the affected joint. Through this incision, a surgeon inserts a camera and fiber optic light, which allows him or her to examine the inside of the joint. The camera image is then projected onto a screen within the operating room, allowing the surgeon to have a real-time view of the procedure area.
While arthroscopy is not a new procedure (the first arthroscopic procedure was done in 1918), the procedure has become more technologically advanced with time, allowing patients a faster recovery.
