ACL reconstruction

Anterior cruciate ligament reconstruction
Arthroscopic anterior cruciate ligament (ACL) reconstruction (right knee). The tendon of the semitendinosus muscle was prelevated, folded and used as an autograft (1). It appears through the remnant of the injured original ACL (3). The autograft then courses upwardly and backwardly in front of the posterior cruciate ligament (2).
ICD-9-CM	81.45
MedlinePlus	007208
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Anterior cruciate ligament reconstruction (ACL reconstruction) is a surgical tissue graft replacement of the anterior cruciate ligament, located in the knee, to restore its function after an injury. The torn ligament is removed from the knee before the graft is inserted in an arthroscopic procedure.

The Anterior Cruciate Ligament is the ligament that keeps the knee stable. Anterior Cruciate Ligament damage is a very common injury, especially among athletes.Anterior Cruciate Ligament Reconstruction (ACL) surgery is a common intervention. 1 in every 3,000 American suffers from a ruptured ACL and between 100,000 and 300,000 reconstruction surgeries will be performed each year in the United States. Around $500 million health care dollar will come from ACL injuries. ACL injuries can be categorized into groups- contact and non-contact based on the nature of the injury Contact injuries occur when a person or object come into contact with the knee causing the ligament to tear. However, non-contact tears typically occur during the following movements: decelerating, cutting, or landing from a jump. ACL injury is 4-6 times higher in females than in males. An increased Q angle and hormonal differences are a few examples of the gender disparity in ACL tear rates.

Three sources of replacement material for ACL reconstruction are commonly used:

Synthetic tissue for ACL reconstruction has also been developed, but little data exists on its strength and reliability.

An accessory hamstring or part of the patellar ligament are the most common donor tissues used in autografts. The quadriceps tendon can also be used if the patellar ligament has been harvested for a previous surgery.

Because the tissue used in an autograft is the patient's own, the risk of rejection is minimal.

Hamstring autografts are made with the semitendinosus tendon, either alone or accompanied by the gracilis tendon for a stronger graft. The semitendinosus is an accessory hamstring (the primary hamstrings are left intact), and the gracilis is not a hamstring, but an accessory adductor (the primary adductors are left intact as well). The two tendons are commonly combined and referred to as a four-strand hamstring graft, made by a long piece (about 25 cm) removed from each tendon. The tendon segments are folded and braided together to form a tendon of quadruple thickness for the graft. The braided segment is threaded through the heads of the tibia and femur, and its ends are fixed with screws on the opposite sides of the two bones.