During ACL Reconstruction Surgery

ACL reconstruction surgery, in most cases, is an outpatient procedure. You'll have your operation at the surgery center or hospital and go home the same day.

Steps of ACL Reconstruction Surgery

ACL reconstruction surgery has some common steps and phases. The sequence may vary based on how your surgeon prefers to do the procedure.

But, for the most part, the process follows these defined steps:

1. Arthroscopy
2. Graft harvesting
3. ACL surgery

Step 1: Diagnostic arthroscopy

Your UPMC Sports Medicine knee surgeon will likely use an arthroscope to look at your knee joint and injured ACL to confirm:

• A correct diagnosis from the pre-surgical tests and assessments.
• The absence or presence of damage to other structures.
• The plans for harvesting the tissue graft from your body match the size and shape of your knee.

Step 2: Graft harvesting

If you have an autograft to repair your ACL, your surgeon will harvest the graft from a tendon in either your:

• Kneecap
• Front thigh
• Hamstring

Your surgeon will make a cut at the harvest site and extract part of the tendon that will become your new ACL.

He or she will decide how much tissue to remove and exactly where on the tendon based on:

• The needs of your injury and anatomy.
• Any findings from your knee arthroscopy in step 1.

Step 3: Reconstruction surgery

To reconstruct your ACL using the graft tissue, your surgeon will:

• Inspect what remains of your native ACL to see where and how it attaches to your thighbone and shinbone.
• Mark the areas on your thigh- and shinbones for attaching the graft to repair your ACL.
• Drill holes, or tunnels, in the marked areas in the matching size — often your thighbone first and then the shinbone.
• Attach a fastening suture to the tunnel on the shinbone and then on the thighbone for pulling the new ACL through.
• Affix the new ACL to your thighbone and hold it in place with a fastening device. There are many kinds of fastening devices. The one your surgeon chooses will depend on a few factors, including the type of graft you're having.
• Hold the other end of the graft and bend and straighten the knee repeatedly. Since the graft tissue tends to stretch out at first, these motions help remove that initial bit of give.
• Pull the graft tight and attach it to the shinbone with a fastening device while bending your knee at about 20 degrees. This position is where your ACL is naturally most taught.
• Look at your knee through the arthroscope to make sure your new ACL has good tension, and all looks as it should.

Depending on your case, you may have other damage in your knee. Your surgeon will make any other necessary repairs before finishing surgery and closing your incisions.

After surgery, you'll move into the recovery room.

How Long Does ACL Reconstruction Surgery Take?

Most ACL reconstruction procedures take two hours or less. Your doctor will let you know about how long you'll be in surgery.

Some factors can affect the time it takes for the entire surgical process, such as:

• The type of graft you're having — either an autograft or allograft.
• Where your surgeon harvests an autograft from your body.
• If your surgeon needs to repair any other ligaments or tissues in your knee, along with your ACL.
• If your surgeon finds damage or issues during arthroscopy that he or she didn't expect or see in your pre-surgical test results.

Learn More About ACL Surgery

Contact the UPMC Sports Medicine ACL Program today to learn more or make an appointment.