Anterior Cruciate Ligament repair is rarely possible. Certain conditions must be met, such as a short time between the injury and surgery, and a ligament rupture at its proximal insertion on the femur.
The surgical treatment of choice is ACL reconstruction (ligamentoplasty) to stabilize the knee. This is performed arthroscopically under general anesthesia or spinal anesthesia. To recreate the ligament, a portion of the tendon around the knee is needed.
The three most common and effective options are the patellar tendon, quadriceps tendon, or hamstring tendons (STG). These three types of grafts have equivalent outcomes. Harvesting a portion of these tendons is done through a minimally invasive technique (small scar). The use of an allograft (tendon from a donor) is not recommended due to the higher risk of rupture (up to 25%). Tunnels are created in the tibia and femur, and the graft is passed through to anatomically recreate the ACL. It is then fixed inside the bone using resorbable screws.
During this surgery, arthroscopy allows the surgeon to evaluate the menisci and cartilage, and treatment is provided in case of injury (e.g., repairing a torn meniscus). Additionally, the anterolateral ligament (ALL) of the knee can also be reconstructed (also by minimally invasive technique). This additional procedure allows better control of knee rotation and reduces the risk of re-rupture of the ACL by threefold and the risk of meniscus repair failure by twofold.
The surgery lasts between 30 to 60 minutes, depending on whether meniscal lesions need to be repaired.
In more severe lesions, it may be necessary to repair or reconstruct one of the collateral ligaments, requiring the use of a hinged brace afterward.
For more details on the anterior cruciate ligament:
Public conference on December 3, 2020: Link
Link to the patient information brochure:
https://www.la-tour.ch/fr/reconstruction-du-lca-ligament-croise-anterieur-informations-pour-le-patient
Special cases :
Children and Adolescents
Caution is taken to avoid damaging the growth plates and special techniques have to be applied to ensure that the procedure does not impede growth. An anterolateral plasty is also added to reduce the risk of graft re-rupture and improve meniscus healing.
The surgical indications are similar to adults: the sensation of instability, the degree of laxity on clinical examination, associated lesions (menisci, cartilage, and other ligaments), and the desire to participate in pivot sports (sports involving direction changes).
New Rupture and ACL Reconstruction Failure
Some patients may experience persistent instability after ACL reconstruction. Several causes can be identified:
The surgical treatment of choice is ACL reconstruction (ligamentoplasty) to stabilize the knee. This is performed arthroscopically under general anesthesia or spinal anesthesia. To recreate the ligament, a portion of the tendon around the knee is needed.
The three most common and effective options are the patellar tendon, quadriceps tendon, or hamstring tendons (STG). These three types of grafts have equivalent outcomes. Harvesting a portion of these tendons is done through a minimally invasive technique (small scar). The use of an allograft (tendon from a donor) is not recommended due to the higher risk of rupture (up to 25%). Tunnels are created in the tibia and femur, and the graft is passed through to anatomically recreate the ACL. It is then fixed inside the bone using resorbable screws.
During this surgery, arthroscopy allows the surgeon to evaluate the menisci and cartilage, and treatment is provided in case of injury (e.g., repairing a torn meniscus). Additionally, the anterolateral ligament (ALL) of the knee can also be reconstructed (also by minimally invasive technique). This additional procedure allows better control of knee rotation and reduces the risk of re-rupture of the ACL by threefold and the risk of meniscus repair failure by twofold.
The surgery lasts between 30 to 60 minutes, depending on whether meniscal lesions need to be repaired.
In more severe lesions, it may be necessary to repair or reconstruct one of the collateral ligaments, requiring the use of a hinged brace afterward.
For more details on the anterior cruciate ligament:
Public conference on December 3, 2020: Link
Link to the patient information brochure:
https://www.la-tour.ch/fr/reconstruction-du-lca-ligament-croise-anterieur-informations-pour-le-patient
Special cases :
Children and Adolescents
Caution is taken to avoid damaging the growth plates and special techniques have to be applied to ensure that the procedure does not impede growth. An anterolateral plasty is also added to reduce the risk of graft re-rupture and improve meniscus healing.
The surgical indications are similar to adults: the sensation of instability, the degree of laxity on clinical examination, associated lesions (menisci, cartilage, and other ligaments), and the desire to participate in pivot sports (sports involving direction changes).
New Rupture and ACL Reconstruction Failure
Some patients may experience persistent instability after ACL reconstruction. Several causes can be identified:
