Anatomic “Transportal” ACL Reconstruction

Anatomic “transportal” ACL reconstruction surgery replaces a torn anterior cruciate ligament (ACL) with tendon tissue grafted from the patient’s patella or hamstrings. Allograft (donated tissue) may also be used for ACL reconstruction. The goal is to  reproduce the normal anatomy of the individual patient’s knee.  A transportal technique optimizes the position of the reconstructed ligament, controls the rotational “pivot” in the reconstructed knee, and  minimizes graft  impingement on  the nearby posterior cruciate ligament (PCL).

Patient Profile:

  • All patients with ACL tears that wish to maintain an active lifestyle
  • Very typical sports injury

The ACL connects the femur to the tibia in the center of the knee joint. ACL tears are very common, especially as a consequence of sports activities.  Generally speaking, ACL fibers cannot be repaired due to irreversible stretching damage at the time of the injury.  It is estimated that over 100, 000 ACL reconstruction surgeries are performed in the US each year.  ACL reconstruction commonly involves placing a tendon graft where the original ACL used to be.

Anatomic ACL reconstruction refers to the concept of individualizing the specific surgery to match the unique anatomy of the patient’s knee – both in tunnel size and location.  Thus, insertion areas are measured to decide what graft size to use for each patient and care is taken to place the new tissue grafts in the exact position of the original ACL..  The injured ACL is then removed with arthroscopic instruments.  Placement of the femoral tunnel must be carefully controlled to avoid impingement with the PCL (posterior cruciate ligament).  The “transportal” technique differs from traditional “trans-tibial” techniques by lowering the position of the femoral tunnel to a more anatomic position. This serves to better control rotational instability in the knee. Rotational instability after ACL reconstruction- the “pivot shift”- is a common cause of continued instability, meniscal tears, and cartilage injury after traditional ACL reconstruction.

Watch a video of Dr. Karas performing mini-incision acl reconstruction surgery here.