Surgery (ACL)

The goal of this procedure is to replace the ruptured ligament, at its anatomical site, with a tendon from the same knee (autograft), without opening the joint (through arthroscopy). Taking a tendon specimen does affect the joint’s functioning. This graft is placed into the joint through small bone tunnels at the level of the tibia and the femur. This intra-articular procedure is performed under arthroscopic control, which reduces scarring and makes rehabilitation faster and less painful.

Tendon specimens are:
– Hamstrings, on the internal side of the knee. We use semitendinosus tendon (ST) and gracilis tendon(GT) They’re on the medial and posterior side of the thigh. Their very long tendons are attached to the internal side of the tibia. They can be taken through a small incision with a device called “stripper”. They are then folded double to obtain a graft with 4 strands, which is much more resistant to traction than a normal ACL.

Benefits of the STGT technique:
easier postoperative recoveries, no residual pain and higher “functional” results than the KJ.
Drawbacks: : former binding problems of these tendons have been solved using new binding modes.

– Patellar tendon below the patella.
Also called Kenneth-Jones procedure(KJ).
The central third patellar tendon is taken out with its patellar and tibial bone attachements. It replaces the cruciate anterior ligament in the notch and the bone plugs enable a strong fixation.

• Benefits of the KJ technique: as it is the oldest technique, the results are well known on the long term.
• Drawbacks of the KJ technique: painful postoperative recoveries, possible persistent residual pain where the patellar tendon has been harvested, and difficulty to kneel down for 30{88b696bf2700d12398c30964f41039de701ab1baffac505c8144f3e2e2571fd4} of patients.

• For some patients (hyper laxity, repeated ACL rupture, high impact sports), an extraarticular ligamentoplasty (Lemaire’s type procedure) can be done during the same surgery, using a fascia lata band through a small incision on the antero lateral side of the knee.
  In case of important rotational instability, an alternative treatment is the reconstruction of both ACL’s anatomical bundles (antero medial and postero lateral bundle) through separated femoral and tibial tunnels (double bundle reconstruction). This is a longer and more difficult technique that should only be used for specific cases.