Anatomy

ACL reconstruction is a cutting-edge, minimally invasive arthroscopic surgery designed to repair a torn anterior cruciate ligament – the critical knee stabilizer essential for pivoting, twisting, and high-impact activities. Often resulting from sports injuries in soccer, basketball, hockey, skiing, or everyday accidents, an ACL tear can cause debilitating symptoms like knee “giving way,” persistent swelling, pain, and limited mobility. If left untreated, it heightens risks of chronic instability, secondary injuries (e.g., meniscus or cartilage damage), and early-onset osteoarthritis.

At OV Surgical, we elevate ACL surgery in Canada with advanced techniques that minimize downtime and maximize results. Through just two tiny incisions (less than 1 cm), our surgeons insert an arthroscope – a small camera – to visualize and address associated knee issues in real-time. Following diagnostic arthroscopy, we make an incision to obtain a graft that will used to recreate the ACL in your knee. To reconstruct the ACL, we prioritize autografts harvested from your own body, such as the patellar tendon, quadriceps tendon, or hamstring tendon, for optimal strength and biomechanical function. Once the knee has been prepared and the ACL graft has been appropriately positioned in the knee, the graft is meticulously secured to the femur and tibia using strong fixation methods. 

In high-risk cases involving severe instability, hyperextension, or revisions, we may incorporate a lateral extra-articular tenodesis (LET) for enhanced rotational control. In this case, a small strip of the iliotibial (IT) band is used to perform the LET augmentation procedure.

Pathoanatomy

Pathoanatomy of rotator cuff tears involves degeneration or trauma leading to partial-thickness or full-thickness disruptions in the tendon fibers. Degenerative tears, common in individuals over 40, result from chronic microtrauma, reduced vascularity in the “critical zone” of the supraspinatus tendon (about 1 cm from its insertion), and age-related collagen weakening, often exacerbated by subacromial impingement where the tendon rubs against the acromion or coracoacromial ligament. Acute tears may occur from falls, heavy lifting, or sports involving overhead activities like swimming, tennis, or baseball. Symptoms include night pain that worsens with overhead reaching, weakness in arm elevation or rotation, limited active range of motion (especially abduction and external rotation), and a positive impingement sign during clinical tests. If left untreated, tears can progress in size, leading to fatty infiltration of the muscles (Goutallier stages), retraction of tendon edges, superior humeral head migration, and eventual cuff tear arthropathy—a form of shoulder arthritis with joint degeneration and pseudoparalysis.

Surgical Technique

At OV Surgical, we specialize in rotator cuff surgery for Canadians with advanced arthroscopic techniques that minimize downtime and maximize results. Through multiple tiny incisions (less than 1 cm), our surgeons insert an arthroscope—a small camera—to visualize the tear and surrounding structures in real-time, including the subacromial space, biceps tendon, and labrum. For full-thickness tears, we perform a subacromial decompression (acromioplasty) to shave down bone spurs or reshape the acromion, creating space to reduce impingement. The torn tendon is mobilized, and its edges are debrided to healthy tissue. Using suture anchors—small bioabsorbable implants inserted into the humeral head—we pass strong sutures through the tendon and reattach it anatomically to its footprint on the greater tuberosity, often in a double-row configuration for enhanced biomechanical strength and footprint compression. In cases of partial-thickness tears (e.g., articular-sided or bursal-sided), we may opt for debridement and transtendon repair if over 50% thickness is involved. For massive or irreparable tears, advanced options like biological augmentation (e.g. Regeneten patch from Smith and Nephew, CuffMend from Arthrex) or tendon transfers may be considered to restore function. The procedure typically lasts 1-2 hours, with meticulous attention to preserving function. The procedure typically lasts 1-2 hours, with meticulous attention to preserving