Procedure Overview
ACL reconstruction is the gold-standard surgical treatment for ACL ruptures.
This is indicated for those who have symptomatic instability of the knee, in settings with multiple injuries (other ligaments or the menisci), and in younger patients planning to return to pivoting sports.
The surgery involves using some form of graft to recreate the biomechanical properties of the ACL, which connects the femur to the tibia in the middle of the knee. Tunnels are drilled into the femur and tibia, allowing a graft (reconstructed ligament) to be passed through the knee mimicking the ACL’s function. It is then secured to the bones using small implants.
Grafts are most typically a tendon harvested from the same leg. The most successful grafts include those taken from the hamstrings or quadriceps/patella tendons. Mr O’Bryan regularly uses all three of these graft options, tailored to each patient’s injury pattern and functional demands. Other grafts exist, such as the Peroneus Longus tendon in the same leg, or donor grafts. These are used by Mr O’Bryan in certain scenarios.
An ACL reconstruction is often combined with another procedure. This is most commonly a procedure on the outside of the knee to recreate the biomechanics of the ALL (anterolateral ligament), which has been shown to drastically reduce the risk of ACL reconstruction failure, as well as show promising results in protecting meniscal repair. Such procedures come in many names (such as the LEAT, LET or LEAP) and techniques such as the Lemaire, Ellison or ALL reconstruction. Mr O’Bryan employs all three of these techniques in various scenarios with an ACL reconstruction, and would include this procedure more often than not during an ACL reconstruction. In essence, a strip of graft (usually from the Iliotibial Band) is passed from the tibia to the femur, usually underneath the LCL, to secure the outside of the knee.
Other frequently related procedures during an ACL reconstruction include meniscus repair, other ligament surgery such as for the MCL, or rarely an osteotomy (usually in revision surgery).
Athletes Treated
Years Experience
Return to Sport