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Arthroscopic ACL Reconstruction

What is the ACL?

The Anterior Cruciate Ligament (ACL) is the main stabilizer of the knee allowing proper movement, function, and athletic pivotal activities, and is one of the most commonly injured ligaments. The ACL controls your leg from unnatural movement or twisting. It and other ligaments in the knee allow the leg to bend and extend without additional stress.

What Causes an Injury?

An ACL injury can be caused by abnormal rotation or hyperextension stresses placed on the knee. An injury will undoubtedly lead to reconstruction if the patient wants to return to their active, healthy, athletic lifestyle.

Reconstruction Surgery

Dr. Hoover specializes in ACL reconstruction surgery. Reconstruction of the ACL and repair of a torn meniscus are among the most commonly performed arthroscopic surgeries. Dr. Hoover performs reconstruction surgery and uses a graft to replace the ligament. Autografts are harvested from the patient’s body, typically from the middle third of their involved leg patellar tendon or hamstring in place of the torn ligament. Another choice is allograft tissue, which is harvested from donor tissue that has passed the highest and most advanced measures of testing and screening.

Dr. Hoover uses arthroscopic surgery rather than open surgery for ACL injuries because:

  • It is easy to see and work on the knee structures.
  • It uses smaller incisions than open surgery.
  • It can be done at the same time as diagnostic arthroscopy (using arthroscopy to find out about the injury or damage to the knee).
  • It may have fewer risks than open surgery.

During arthroscopic ACL reconstruction, Dr. Hoover makes several small incisions-usually two or three-around the knee. He then inserts an arthroscope into one of the other incisions. A camera at the end of the arthroscope transmits pictures from inside the knee to a TV monitor in the operating room.

Surgical drills are inserted through other small incisions. Dr. Hoover drills small holes into the upper and lower leg bones where these bones come close together at the knee joint. The holes form tunnels through which the graft will be anchored.

He will also make another incision in the knee and take the graft (replacement tissue). The graft is pulled through the two tunnels that were drilled in the upper and lower leg bones. The surgeon secures the graft with hardware such as screws or staples and will close the incisions with stitches or tape. During ACL surgery, Dr. Hoover may repair other injured parts of the knee as well, such as menisci, other knee ligaments, cartilage, or broken bones.

Revision Reconstruction Surgery

After a primary reconstruction surgery there is always a chance that the reconstructed ACL could be injured. If the reconstructed ACL is injured or torn, it may take either one or two additional surgical procedures to complete the ACL revision reconstruction. Revision reconstruction consists of debriding and removing the primary ACL graft along with the screws that held the previous reconstructed ACL in place. Removing this hardware might leave holes in the bone that are too loose and/or too wide for the new screws and grafts to securely fixate in the second reconstruction. Under these circumstances a bone grafting process is necessary in order for the fixation tunnels to heal to accommodate the revision graft. The bone grafting allows the widened holes from the prior surgery to be filled so that when the revision reconstruction is performed the screws have a tight fit. Following bone grafting, the revision reconstruction can be performed approximately three months later. Dr. Hoover does perform many revision reconstructions using a single stage process. Your options will be intimately discussed prior to surgery.


How can I schedule an appointment?

If you would like to schedule a consultation, please call our office at (865) 316-3650.