# ACL Reconstruction

> Citation bundle for ACL Reconstruction on The Treatment Registry.
> URL: https://thetreatmentregistry.com/procedures/acl-reconstruction
> Bundle URL: https://thetreatmentregistry.com/api/citations/procedures/acl-reconstruction

- Category: orthopaedic

## Description

Anterior cruciate ligament 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 can either be removed from the knee, or preserved before reconstruction through an arthroscopic procedure.

## Overview

Anterior cruciate ligament (ACL) reconstruction is a surgical tissue-graft replacement of the anterior cruciate ligament in the knee, carried out to restore the ligament's function after an injury. It is performed arthroscopically; the torn ligament is usually removed, although in some techniques it is preserved and the graft is passed inside the retained native ligament. Several graft options exist. Autografts use bone or tissue taken from the patient's own body — most commonly an accessory hamstring tendon or part of the patellar ligament, with the quadriceps tendon becoming more widely used. Allografts use tissue from another body, either a cadaver or a live donor. Bridge-enhanced ACL repair uses a bio-engineered scaffold injected with the patient's own blood, and synthetic grafts have also been developed, though little data exists on their strength and reliability. Because autograft tissue is the patient's own, the risk of rejection is minimal, and in young, active individuals the re-tear rate has been shown to be lower with autograft than with allograft. Surgeons have historically regarded patellar tendon grafts as the standard for knee stability. Hamstring autografts have failed at a somewhat higher rate than bone-tendon-bone autografts in a 2017 meta-analysis, but the difference is small enough that both remain viable options; modern fixation methods have reduced the graft slippage and stretching that hamstring grafts historically showed.

## FAQs

### What is ACL reconstruction?

It is a surgical tissue-graft replacement of the anterior cruciate ligament in the knee, performed to restore the ligament's function after an injury. It is carried out arthroscopically, and the torn ligament is usually removed, though in some techniques it is preserved and the graft is passed inside it.

### What types of graft are used?

Options include autografts, using bone or tissue from the patient's own body such as a hamstring tendon, part of the patellar ligament or the quadriceps tendon; allografts, using tissue from a cadaver or live donor; bridge-enhanced ACL repair, using a bio-engineered scaffold injected with the patient's own blood; and synthetic grafts, on which little data exists.

### Is autograft or allograft better?

Because autograft tissue is the patient's own, the risk of rejection is minimal, and in young, active individuals the re-tear rate has been shown to be lower with autograft than with allograft. Surgeons have historically regarded patellar tendon grafts as the standard for knee stability.

### How long does recovery take?

About six weeks is needed for the bone to attach to the graft, though patients can usually walk with caution before then. Twelve weeks is an important benchmark, after which more demanding exercise and jogging can begin. Running is generally possible after four months, and light ball work after five months.

### Is the torn ligament removed during surgery?

In most cases the torn ligament is removed. In some techniques it is preserved, and the graft is passed inside the retained ruptured native ligament.

### Can the graft fail or re-tear?

Yes. Hamstring autografts have failed at a somewhat higher rate than bone-tendon-bone autografts in a 2017 meta-analysis, and historically had problems with fixation slippage and stretching. Modern fixation methods have reduced graft slippage and produce comparably stable outcomes, so both remain viable options.