A patellar tendon graft is a surgical procedure used to reconstruct ligament tissue in the knee. The anterior cruciate ligament (ACL) is one of the main sources of stability and control in the knee, and it is the most common site for a patellar tendon graft. The procedure to repair a torn ACL involves removing tissue from the patellar tendon in the front of the knee and using it to reconnect the damaged ligament in the back. Grafts have a high success rate, and many people are able to return to normal activity levels in six months to one year following surgery.
A team of doctors and surgeons considers a patellar tendon graft when there is not enough healthy ligament tissue remaining to salvage an injured ACL. Before the procedure, a consultation is scheduled to make sure a patient is a good candidate for surgery. A physical exam and x-rays can confirm that the patellar tendon is strong enough to withstand losing a section for the graft. In addition, doctors can explain the procedure and its risks in detail to make sure the patient is comfortable.
Most patellar tendon grafts take place in hospitals while patients are kept under both general and local anesthesia. A surgeon first makes an incision just below the kneecap, locates the patellar tendon, and snips away a middle section from the kneecap to the tibia below. Another pair of incisions are made behind the knee to gain access to the ACL. Using an endoscopic camera and precision tools, the surgeon carefully removes the damaged section of the ligament and plans out how to attach the graft.
The surgeon drills a small hole or notch in both the tibia and the upper leg bone, the femur, to support the graft. Using high strength line, the patellar tendon graft is pulled tightly through both holes until it is in the same position as an ACL should be. Hard synthetic bone material is used to fill in the holes, and screws are inserted into both bones to keep the tendon in place. The surgeon can then suture the surgical incisions to finish the procedure.
Following surgery, a patient is usually kept in the hospital for at least one night so doctors can check for complications such as infections, internal bleeding, and adverse reactions to anesthesia. He or she is then prescribed painkillers and given either crutches or a wheelchair to take home. After a two- to six-week period of rest, the patient can begin attending physical therapy sessions to rebuild strength and flexibility in the leg. Most people experience near full recoveries from patellar tendon graft surgery in less than a year when they follow their doctors' orders and stick with physical therapy routines.