Dr Gardner is an expert in ACL reconstruction, including the use of all autografts (patella tendon, quadriceps tendon and hamstring tendons) and allograft (donated tendon tissue) and revision (redo) ACL surgery. Additionally, she is a regional leader in the use of the lateral extra-articular tenodesis procedure for added protection of the ACL graft (in certain cases).
As a former collegiate athlete and current collegiate team physician, Dr Gardner understands that an ACL injury is not just a physical injury – it affects all aspects of life, including mental health. She will work with the athlete and their family and treatment team to maximize all aspects of their recovery and return them to the field as safely as possible.
What is ACL Reconstruction?
Anterior cruciate ligament (ACL) reconstruction is a surgical procedure to replace a torn or damaged ACL ligament in your knee with a new ACL tissue graft obtained most commonly from your own body (autograft) or in rare cases from a deceased donor (allograft).
The most common autografts are the patellar tendon (tendon of the kneecap) or one of the hamstring tendons (tendons located at the back of the thigh). In some instances, the quadriceps tendon located above the kneecap is utilized. Tendons are cords of strong fibrous tissue that connect muscles to bones. Ligaments are tough bands of tissue that connect one bone to another bone.
ACL tears or injuries most often occur during sports activities that involve pivoting, cutting, and turning movements as in football, soccer, skiing, tennis, and basketball.
Anatomy of the ACL
The anterior cruciate ligament is one of the major stabilizing ligaments in the knee. It is a strong rope-like structure located in the center of the knee, running from the femur (thighbone) to the tibia (shinbone). The ACL is one of the four major ligaments of the knee that connects the femur to the tibia and helps stabilize your knee joint. It prevents excessive forward movement of the tibia in relation to the femur as well as limits rotational movements of the knee. When this ligament tears, unfortunately, it does not heal on its own and often leads to the feeling of instability in the knee, requiring reconstruction to correct the abnormality.
Indications for ACL Reconstruction
An ACL tear or injury is the main indication for ACL reconstruction surgery. An ACL injury is a sports-related injury that occurs when the knee is forcefully twisted or hyper-extended. An ACL tear usually occurs with an abrupt directional change with the foot fixed on the ground or when the deceleration force crosses the knee. Changing direction rapidly, stopping suddenly, slowing down suddenly while running, landing from a jump incorrectly, and direct contact or collision, such as a football tackle can also result in injury to the ACL.
Procedure for ACL Reconstruction
ACL reconstruction surgery is usually performed under general anesthesia using a minimally invasive arthroscopic technique. In general, the procedure involves the following steps:
- Your surgeon will make two to three small cuts, about 1/4-inch-long, around your knee.
- An arthroscope is inserted into the knee joint through one of the incisions.
- An arthroscope is a thin tubular instrument with a camera, light, and a magnifying lens attached at the end that is connected to an external monitor and enables your surgeon to view the inside of the knee joint.
- Along with the arthroscope, a sterile solution is pumped into the joint to expand it, enabling your surgeon to have a clear view and space to work inside the joint.
- Miniature surgical instruments are passed through the other incisions and the torn ACL is removed and the pathway for the new ACL tendon graft is prepared.
- Your surgeon makes an incision over the knee or hamstring area and takes out a part of the patellar, hamstring, or quadriceps tendon to prepare the new ACL graft.
- Small holes are drilled into the upper and lower leg bones (femur and tibia) where these bones come together at the knee joint. The holes form tunnels in your bone to accept the new graft.
- The graft is pulled through the predrilled holes in the femur and tibia and fixed into the bones with screws or suture anchors.
- After confirming satisfactory reconstruction, the scope and the instruments are withdrawn, and the incisions are sutured and bandaged.
Risks and Complications
ACL reconstruction surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Infection
- Bleeding
- Pain and weakness in the knee
- Adverse reactions to anesthesia
- Blood clot or deep vein thrombosis
- Damage to adjacent soft tissue structures
- Stiffness or decreased range of motion
- Re-rupture of the graft
- Non-healing of the ligament
