Arthroscopic ACL Reconstruction

Arthroscopic ACL reconstruction is a minimally invasive procedure used to restore stability to a knee after an anterior cruciate ligament (ACL) tear. In most cases, an injured ACL cannot be repaired or stitched back together due to the nature of the tear. Instead, the ligament is reconstructed using a graft—typically tissue taken from another area of the patient’s own body—to create a strong, functional replacement ligament.

This procedure is performed using an arthroscope, a small camera, along with specialized surgical instruments, rather than a large incision. As a result, patients often experience less post-operative pain, a lower risk of infection, and a faster return to activity and sport compared to traditional open surgery.

This procedure is the standard for treating ACL tears in active individuals who want to return to their previous level of function. At Sano Specialty Care, our expert knee surgeons specialize in arthroscopic techniques to help you regain confidence in your knee’s strength and stability.

While not every ACL tear requires surgery, reconstruction is often the best option for individuals who:

• Train as athletes or lead highly active lifestyles.
• Experience persistent knee instability or “giving way” during daily activities.
• Have injured multiple parts of their knee, such as the meniscus or other ligaments, at the same time.
• Work in physically demanding jobs that require a stable knee.

The decision to proceed with surgery is made together with your orthopedic specialist after a discussion about your injury, lifestyle, and personal goals. Talk to a knee specialist or visit our urgent care if you need to be seen quickly.

During an arthroscopic ACL reconstruction, your surgeon performs several steps through small incisions:

1. Examination Under Anesthesia: Once you are asleep and your muscles are fully relaxed in the operating room, the surgeon will perform a thorough physical examination of the injured knee as ACL tears do not always occur in isolation. This assessment allows the surgeon to evaluate the degree of instability and identify any additional injuries, including damage to the collateral ligaments (MCL or LCL). A pivot-shift test may also be performed to assess rotational instability and determine whether treatment of the anterolateral ligament may be necessary. Identifying and addressing all injured structures is essential to restoring knee stability and achieving the best possible surgical outcome.
2. Arthroscopic Inspection: The procedure then begins with the insertion of an arthroscope—a small camera that allows the surgeon to clearly visualize the inside of the knee joint. During this step, the surgeon carefully inspects the ACL, as well as other important structures such as the meniscus and cartilage, to confirm the extent of injury and address any additional damage.
3. Graft Harvest: After any associated ligament or meniscal injuries are addressed, the surgeon prepares the tissue that will be used to reconstruct the ACL. Common graft options include the patellar tendon, hamstring tendon, or quadriceps tendon. In active individuals, autografts (using the patient’s own tissue) are typically preferred over allografts (donor tissue) due to improved strength and healing potential.
4. Graft Placement and Fixation: Small tunnels are then created in the shinbone (tibia) and thighbone (femur). The new graft is passed through these tunnels and securely fixed in place, recreating the function of the native ACL. This reconstructed ligament provides immediate stability to the knee and serves as the foundation for healing and rehabilitation.