Single Bundle ACL Reconstruction: Step by Step

An Anterior Cruciate Ligament (ACL) tear is the most common ligamentous injury of the knees. ACL reconstruction restore stability and kinematics of the knee joint, by improving knee stability. There are so many surgical techniques in ACL reconstruction. One of the most common technique is Single Bundle ACL reconstruction with the hamstring autograft. A good knowledge about operating technique and step by step approach are crucial for successfully procedure. The first step is patient positioning, including the leg holder should be placed proximal enough to allow full knee flexion and extension during procedure, it should be checked before starting the procedure. The second step is graft harvest, the autograft is prepared from the affected knee hamstring muscles, make a proper identification of the Gracilis and Semitendinosus tendon. The third step is portal placement, make a good native ACL attachment identification. Fourth step is femoral tunnel creation, avoid posterior wall blowout. Fifth step is tibial tunnel creation, remaining ACL fibers should be a landmark of the native ACL insertion site. Preserve the meniscal root insertion to prevent iatrogenic meniscus root avulsion. Sixth step is fixation, cycle the knee several times while applying traction to remove any slack out of the graft and to make sure there is non-impingement when fix the graft.