What are the different types of ACL reconstruction procedures?

Anterior cruciate ligament (ACL) reconstruction is a common procedure performed to restore stability to the knee after an ACL tear, typically caused by sports injuries or trauma. There are various methods of ACL reconstruction, each involving different graft types and surgical techniques, tailored to meet individual patient needs.

Types of ACL reconstruction procedures

One of the most commonly used grafts in ACL reconstruction is the autograft, which involves taking tissue from the patient’s own body, usually from the hamstring or patellar tendon. A hamstring graft uses two or four strands of the patient’s hamstring tendon to recreate the ACL. This technique is favored for its strength and relatively lower postoperative pain, but there is a risk of hamstring weakness.

A patellar tendon graft, on the other hand, uses a portion of the patellar tendon with bone segments attached on each end, providing a strong graft that integrates well into the knee. However, patients may experience greater pain and potential kneeling discomfort post-surgery, making it more suitable for younger, highly active patients.

Another option is the allograft, where tissue is taken from a donor instead of the patient’s body. Allografts can include patellar, hamstring, or Achilles tendons, depending on availability.

Since allografts avoid the need for a second surgical site, they often lead to shorter surgical times and reduced postoperative pain. This method is particularly popular for older patients or those undergoing revision surgeries, though it carries a slightly higher risk of graft rejection or disease transmission.

Double-bundle reconstruction is a more complex procedure designed to closely replicate the natural structure of the ACL, which has two functional bundles: the anteromedial and posterolateral. This technique aims to provide better rotational stability by reconstructing both bundles, leading to potentially superior joint stability in certain patients, especially athletes. However, it is technically demanding and may not be suitable for all cases.

Regardless of the type, ACL reconstruction is generally performed arthroscopically, a minimally invasive method that uses a small camera and instruments to repair the ligament with minimal disruption. Recovery involves several months of physical therapy and gradual strengthening to restore full knee function, and the chosen reconstruction technique should align with the patient’s activity level, age, and individual anatomy to achieve optimal outcomes.