After the anesthesia is given, a tourniquet or blood pressure cuff, is wrapped around the thigh to temporarily stop the flow of blood to the knee. This allows the doctor to see the surgical area clearly. To help reduce the chance of infection, the area will be scrubbed with a special soap, and will be covered with sterile sheets. The only area exposed will be the site where the procedure is being performed.
The doctor will begin the surgery by making three small incisions about a quarter inch in length. One is located above the kneecap and the other two are below. The knee is then filled with fluid to expand the joint so that the doctor can see better inside. Through one of the incisions, the arthroscope is then inserted. The arthroscope is long and thin, about the size of a writing pen. It acts as a camera that projects an image onto a TV monitor so the doctor can see inside your knee. It can also take pictures and videotape the procedure.
Once the arthroscope is in the correct position, the doctor will begin to examine the structures of the knee on a video monitor, looking for any damage to the menisci or articular cartilage. If an injury is seen, the doctor will treat it at that time. When the cartilage work is done, the doctor will then proceed with the ACL reconstruction. The doctor will first remove the torn ends of the ACL. It will then be replaced with an ACL graft from your patellar tendon.
To do this, another incision is made in the front of the knee and one-third of the patellar tendon with a piece of bone attached to either end is removed. Because this graft is taken from the middle of the patellar tendon, the tendon is reattached with stitches that the body will absorb over time. There are no long-term defects after taking the graft from this location.
A tunnel where the graft will eventually go is created, starting in the shinbone, through the knee and into the thigh bone. The graft is then placed into the tunnel and usually secured into place with two screws, one in the shinbone and the other in the thighbone.
After the doctor has completed the work within the knee all of the instruments will be removed and the fluid will be drained. The skin incisions will be closed using stitches and a sterile bandage will be applied. A hinged knee brace may be placed to lock your knee in a straight position.