Reconstruction of the ligament can be with an, AUTOGRAFT (your own tissue obtained from elsewhere in your body, usually the affected leg), or with an ALLOGRAFT (tissue from organ donors). Artificial or synthetic ligaments are basically no longer used and were only available for use in knees that had previously failed reconstruction as per FDA guidelines. Allograft or tissue from organ donors, have been successfully used to reconstruct the ACL.
Their continued use is determined by the availability of the patient’s own tissue which can be used as a graft or if the patient requests one. There are circumstances of multiple knee ligament injuries, where an insufficient amount of your own tissue is available; an allograft becomes the only reasonable option.
Autograft (your own tissue) seems to be the best substitute for the ACL. It is obtained by taking the central portion (middle 1/3) of the patella tendon (located on the front of the knee). As much as 50% of this tendon can be harvested without significantly weakening the extensor mechanism.
Some studies have even demonstrated a regeneration of this tendon following harvest. Although there are many different types of autograft reconstructions, the patella tendon free graft is the “state-of-the-art” and “gold standard” for ACL reconstruction.
This procedure requires two small incisions or one relatively short incision, over the front of the knee to harvest the patella tendon graft while the rest of the procedure is performed arthroscopically. The patella tendon graft is harvested along with two small wedges of bone, one from the kneecap and one from the shin bone.
The graft is then moved in to the appropriate position to replace the ACL; it is passed through drilled tunnels in the shin bone and thigh bone, and anchored into place using the wedges of bone and screws. The entire procedure usually takes 2 to 2 ½ hours and routinely performed on an out-patient basis.
DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT ON THE DAY OF YOUR SURGERY. DO NOT TAKE ANY ANTI-INFLAMMATORY MEDICATIONS SUCH AS ASPIRIN, ADVIL, ALEVE, NAPROSYN, ETC. FOR 10 DAYS PRIOR TO YOUR SURGERY. If insect bites, scratches, or pimples occur on or around the knee prior to surgery, contact the office immediately (201) 343-1717.
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