Arthroscopic anatomic ACL reconstruction replaces a torn anterior cruciate ligament with a tendon graft placed in the native ACL footprints on the femur and tibia. The procedure restores rotational stability to the knee and allows return to pivoting sport. Dr. Chudik has developed arthroscopic techniques for the most complex variants of this procedure, including pediatric growth-plate-sparing reconstruction and revision reconstruction, that are used by surgeons internationally.
What Is Arthroscopic Anatomic ACL Reconstruction?
The ACL is the rope-like ligament that controls rotational and anterior-posterior stability of the knee. When torn, it does not heal. ACL reconstruction replaces the torn ligament with a tendon graft (autograft from the patient’s own tissue or allograft from a donor).
Anatomic reconstruction places the graft in the exact native ACL footprints on the femur and tibia, replicating the original ligament’s biomechanics. Older techniques placed graft tunnels in non-anatomic positions and produced inferior rotational stability. Modern anatomic technique is the standard of care.
Graft options include:
- Patellar tendon (bone-tendon-bone): strong fixation, donor site morbidity at the kneecap
- Quadriceps tendon: increasingly common, less anterior knee pain than patellar tendon
- Hamstring tendon: less donor site pain, more variable graft size
- Allograft (donor tissue): no donor site morbidity, slower incorporation than autograft
The choice depends on patient age, activity level, prior knee surgery, and individual factors.
Who Is a Candidate?
Candidates for anatomic ACL reconstruction typically have:
- A complete ACL tear documented on examination and MRI
- Active patients who want to return to pivoting sport, manual labor, or active lifestyle
- Knee instability with daily activities or sport
- Associated meniscus or ligament injuries that warrant surgical management
Patients willing to modify activity to avoid pivoting sports may consider non-surgical management, particularly older patients and those with partial tears.
For specific patient groups, Dr. Chudik has developed specialized techniques:
- Skeletally immature athletes: Arthroscopic Pediatric Growth-Plate-Sparing ACL Reconstruction
- Failed prior ACL reconstruction: Arthroscopic Revision ACL Reconstruction
How the Procedure Is Performed
The procedure is performed entirely arthroscopically through standard portals. The torn ACL is identified and the remaining stump is removed. The femoral and tibial native ACL footprints are identified using anatomic landmarks.
The graft is harvested (for autograft) or prepared on the back table (for allograft). Bone tunnels are drilled at the femoral and tibial native footprints, with diameter matched to the graft size. The graft is shuttled through the tunnels and tensioned. Fixation is achieved with interference screws, cortical buttons, or a combination depending on graft type and bone quality.
Associated meniscus tears are repaired or trimmed at the same procedure. Dr. Chudik prioritizes meniscus repair over removal whenever the tear pattern allows.
Recovery and Rehabilitation
Recovery follows a structured protocol:
- Weight-bearing as tolerated immediately, often with brace and crutches
- Range of motion exercises beginning the day of surgery
- Progressive strengthening over three to six months
- Sport-specific training and neuromuscular work in the late phase
- Return to sport after objective return-to-play testing, typically six to nine months
Dr. Chudik uses an objective return-to-sport testing protocol to confirm readiness rather than relying on time alone. Testing includes strength symmetry, hop tests, and functional movement assessment.
Risks and Outcomes
Risks include re-tear (5 to 10 percent in primary cases), graft site morbidity for autograft, stiffness, infection, and persistent instability. Re-tear rates are higher in young athletes returning to pivoting sport.
Outcomes are very good in appropriately selected patients, with most returning to pre-injury sport. Factors that affect outcome include associated injuries, graft choice, surgical precision, and rehabilitation adherence.
Why Dr. Chudik for Arthroscopic ACL Reconstruction
Dr. Chudik treats the full spectrum of ACL pathology, from primary anatomic reconstruction to the most complex pediatric and revision cases. He has developed techniques for both Pediatric Growth-Plate-Sparing ACL Reconstruction and Revision ACL Reconstruction that are used by surgeons internationally. For primary cases, his high case volume and arthroscopic experience produce reliable outcomes with attention to associated meniscus and ligament pathology.