The anterior cruciate ligament (ACL) connects the femur (thighbone) to the tibia (shinbone) at the knee. If the ACL is torn in a sport, work or other activity injury, your knee may become unstable. To restore stability, surgery may be needed to replace the ACL with your own connective tissue, donor tissue or artificial tissue. There may also be meniscus repair needed if this shock-absorbing knee material is damaged. Various options for commonly performed ACL surgeries are listed below. Each of the choices are usually performed with an arthroscope--a thin medical device with a mounted camera--so the surgeon can see what he's doing without making a large incision.
Meniscus Repair
The shock-absorbing meniscus, which is the cartilage located at the top of the shinbone, may need to be repaired as part of the ACL surgery. According to Mayo Clinic staff, as much healthy meniscus as possible should be preserved to avoid arthritic problems later in life. It also advises against doing meniscus repair without ACL reconstruction because unless ACL repairs are made, the knee may become less stable.
Autografts
In an autograft repair, the surgeon uses the patient's own tendon material to replace the torn ACL. The autograft may come from your hamstring or patellar tendon. The surgeon drills a hole through the tibia into the femur where the torn ligament was, passes the tendon material through the hole and holds it in place with a screw at each end. Using your own tissue may weaken the area where the tendon is taken from, so this procedure may not be used for certain sports injuries in which the athlete intends to continue stressful activities.
Allografts
In an allograft repair, the tendon material comes from a donor cadaver, so the patient isn't weakened in another area. Because there is no second incision, the patient may also recover quicker than if an autograft is used. The repair is made the same way, whichever material is used.
Synthetics
Mayo Clinic staff report some experimental use of synthetic grafts instead of either allografts or autografts. This procedure has yielded a higher degree of failures, however, with no significant advantages over the other procedures.
