Orthopaedics – Surgeries – Treatment
Treatment of Knee Conditions
Anterior Cruciate Ligament (ACL) Reconstruction
Anterior Cruciate Ligamentoplasty: Grafts and Techniques
Ligamentoplasty of the anterior cruciate ligament (ACL) is the main surgical solution in cases of rupture, aiming to restore the stability of the knee and reduce the likelihood of further damage or osteoarthritis. During the operation, the damaged ACL is replaced by a graft, mainly obtained from the patient (autograft).
Grafts
The autografts come from:
- Patellar Tendon: It includes a tendon with bone fragments at its ends, which facilitates its rapid integration into the bone tunnels. Although it is effective and durable, it can cause anterior pain or affect the extensor mechanism of the knee.
- Quadriceps Tendon: It is used with or without a bone fragment and is considered very durable. The latest studies highlight it as an excellent choice.
- Hamstring Tendons (semitendinosus and gracilis): Although they do not contain bone segments, they form a strong quadruple-bundle graft and are associated with low donor site morbidity.
In cases where autografts cannot be used, allografts from cadaveric donors or synthetic grafts are selected, although these are considered last-resort solutions.
Arthroscopic Ligament Reconstruction
The procedure is performed arthroscopically, offering minimal surgical trauma and quick recovery. The main requirement is the correct anatomical positioning of the graft in the thigh and tibia to ensure normal knee stability. Accurate placement reduces the likelihood of failure and the need for repeat surgery.
Modern practice includes Lateral Extra-Articular Tenodesis (LET) as an additional technique, which enhances stability and reduces the risk of a new rupture, especially in athletes and young patients.
The combined use of the arthroscopic technique and the selection of an appropriate graft ensures the best possible results, allowing patients to return to their daily and sporting activities with safety and stability.
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