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Dr. James Chen, M.D. - In San Francisco, CA

Dr. Chen’s surgical technique for ACL reconstruction tunnel placement

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An arthroscopic and open procedure performed to replace a torn Anterior Cruciate Ligament (ACL) with a tendon graft. Two small incisions are made on the front of the knee. An arthroscopic camera and instruments are used to clear the torn ACL away from its bone attachment sites in the knee. A tunnel is drilled at the femoral attachment site from inside the knee. Another small incision is made just below the knee. A drill guide is used to drill a tunnel from outside the tibia to the tibial attachment site for the ACL inside the knee. The tendon graft can then be passed through the tibial tunnel and seated in the femoral tunnel. The graft is secured in the tibia with an absorbable screw.


Dr. Chen's surgical technique for graft retensioning using an adjustable-loop fixation device in arthroscopic ACL reconstruction has been featured in Arthroscopy Techniques - The Journal of Arthroscopic and Related Surgery.

Graft Retensioning Technique Using an Adjustable-Loop Fixation Device in Arthroscopic Anterior Cruciate Ligament Reconstruction

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Common Questions about Anterior Cruciate Ligament Reconstruction

How does an ACL work?

The ACL prevents anterior tibial translation and rotational instability in the knee. It is what keeps your knee stable when you cut or pivot or change directions.

How is an ACL surgery performed?

ACL surgery is performed arthroscopically through a camera and 2 or 3 small incisions around the knee. An ACL graft (your own tissue or a cadaver) is used as your new ACL. It is fixated in the knee through the use of buttons or plastic screws.

Who is a good candidate for ACL surgery?

ACL surgery is appropriate for patients who have a full rupture of the ACL, clinical instability of the knee, and a well-preserved knee. Most often this is performed in patients who play cutting and pivoting sports such as soccer, tennis, volleyball, basketball, football, skiing or snowboarding. Even if you do not not play those sports and feel instability in your knee you may be a candidate. ACL surgery is not indicated in a patient with moderate to severe arthritis of the knee.

How long does ACL surgery take?

ACL surgery is generally performed in under two hours but may be longer if there are other procedures performed at the same time such as meniscus or cartilage repair.

What is the best graft for an ACL?

Several studies show that an autograft (your own tissue) has the lowest re-rupture rate in you are under 25 years of age. In general at age 40 years and older there is no difference beween autograft and allograft (cadaveric tissue). From ages to 30 to 40 years of age, the type of graft depends on the expected demand and activity level of a patient.The most commonly used autografts are hamstring and patellar tendon. The most commonly used allografts are ankle, hamstring, and Achilles tendon.

What is ACL surgery recovery like?

Crutches are used for approximately 2 weeks until the patient can walk steady. Stationary bike is begun at 2 weeks. A hinged knee brace is worn for 6 weeks. Jogging is permitting at 4 months. Sport-specific drills such as dribbling and shooting baskets are allowed at 6 months. Full return to sport is between 8 to 10 months.

Dr. Chen's education video on Bone Patellar Tendon Bone ACL Reconstruction

Dr. Chen’s surgical technique for ACL graft passage

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