ACL Tunnel Placement is Necessary for a Good Outcome - Dr Mora

ON THE TOPIC OF ACL SURGERY Anterior Cruciate Ligament (ACL) surgery is successful in the majority of cases. Even though we’ve been doing this surgery for many years and our technique continues to improve, failure still happens in a small percentage of patients. ACL surgery failure can be due to numerous reasons. Some of which include graft malposition (non-anatomic tunnel placement), traumatic (aggressive activity during first 3 months), biologic graft failure, rehabilitation issues and infection. Femoral Tunnel malposition is one of the most common technical reasons for anterior cruciate ligament reconstruction (ACL) failure. Small changes in tunnel placement can result in significant differences in outcome. More anatomic placement of the tunnels can lead to greater knee stability and a more accurate reproduction of native knee kinematics. Replicating the natural anatomy during surgery is one of the keys to a successful outcome. In this video I explain the function of both ACL bundles. AM bundle controls anterior to posterior translation. The PL bundle controls rotation. A graft placed too vertically will lead to rotational instability i.e., giving way during a quick turn. A graft placed too anterior will lead to loss of extension. If it’s too posterior the knee will be tight in flexion. Graft position is just one of the many critical details necessary for a successful outcome after ACL surgery. What can you do to increase the chance of a good outcome after your ACL surgery? A surgeon that does an ACL reconstruction in 35 minutes is not necessarily going to do the best job. I may be biased but having a surgeon with Sports Medicine Fellowship training and one who dedicates their practice to the treatment of the ACL is very important. Also having a surgeon who will spend time with you after the surgery to help identify post surgical problems early, guide the rehabilitation and support you during your recovery can make the biggest difference. I hope you found this information helpful. Please let me know if you have questions. Cheers.