ACL Reconstruction

Michael Eckhoff, MD

Content Contributor

Evolution of ACL Reconstruction

The first ACL reconstruction techniques were done by suturing the graft directly to the bone, however this did not allow for tensioning the graft and was overall a poor fixation technique. Tension on the reconstructive graft is extremely important for it to provide stability. Later, sutures that were attached to the graft were fixed to the bone by a screw.

The screw was a stronger fixation point and allowed for graft tensioning. Washers have been developed to help with fixation strength. Problems arose with the screw and washer systems as they can be symptomatic and in the unfortunate case of revision, reconstructions can be difficult to remove and potentially lead to bone loss. To reduce incision number and size, arthroscopic techniques have been developed to fixation. This includes interference screws and cortical buttons.

Interference screws work by producing large amounts of friction between the graft and the tunnel wall within each bone. This compression and friction prevent the graft from loosening. For cortical buttons the graft is attached to sutures which hold tension on the graft after being affixed to the bone by use of the implant. Cortical button fixation has been shown to provide the strongest load to failure of fixation techniques.

Technology Spotlight

Arthrex Graftlink™

Arthrex Graftlink™ is a system optimized for minimally invasive surgery. It uses special reverse, flip-cutting drills that can create easily directed tunnels in the tibia and femur and cortical button and suture fixation through small poke-hole type incisions.

All of this can occur with arthroscopic guidance. The system can be used with either autograft or allograft tissue. This system allows for strong fixation, with easily oriented tunnels, with a minimal need for incision size.