ACL Surgery

Phone : 02032398823

Email : [email protected]

TLS  (Tape Locking Screw) - ACL Reconstruction technique is a technique developed in France over the last 13 years, this is the standard technique Prof Paul Lee use to treat his patient to ensure speedy recovery.  This technique solved some of the common issues that have been present in tradional ACL surgery, particularly the common occurrence of small grafts. 


It is accepted that the hamstring tendon is the gold standard in terms of ACL graft material. Other tendons such as the patellar tendon can be used to create an ACL graft and there have also been numerous artificial ligaments used in ACL surgery over the years but the Hamstring has been the most commonly used material in primary ACL reconstruction. Through it’s novel design, the TLS ACL can use only a single hamstring tendon, rather than the traditional two, to form a thick and short ACL graft that is bio-mechanically stronger than the native ACL. This large diameter ACL graft is held in place by the strongest fixation available in TLS ACL reconstruction. The superior bio-mechanics of the Short Graft ACL combined with this excellent fixation leads to a stiffer and stronger graft from the outset which means that walking can begin immediately without the need for a brace and rehabilitation can be accelerated.


The TLS - ACL Reconstruction uses just a single hamstring as it's graft material. 


Traditional (common) ACL surgery over the last 15 years has used two hamstring tendons, the semi-tendonosis and gracilis, to form a new ACL. These tendons are found in the back of your medial thigh and attach on the upper-inside part of your shin. They act to bend or flex the knee and also provide some rotational stability. A lot of people who undergo Hamstring ACL surgery report pain from around the harvest area. Also with people who return to sports or running after ACL reconstruction, the hamstring pain or weakness can cause an issue when increasing exercise load. 

With the TLS - ACL technique, the gracilis muscle is spared. As a result, patients tend to report less pain around the donor site. The have been numerous studies looking at the importance of the gracilis muscle and they have found that patients who have both tendons removed during ACL surgery do have less strength overall in their knee flexion than those who have the gracilis tendon preserved. 

The tendon also provides rotational stability to the knee, it stands to reason that by leaving it intact it will act as a mechanism for protecting the new ACL graft after surgery.



The TLS - ACL replaces large motorized drills with gentle hand-reamers for a portion of the surgery. This combined with the harvest of only a single hamstring has been shown to reduce the amount of post-operative pain patients feel when they have undergone their ACL surgery. There is less bone and tendon trauma compared to any other traditional ACL technique.

Obviously this benefits the patients experience post-op but it is also an important factor that allows for early mobilisation and exercise as the muscles around the joint are not inhibited by pain.


The fixation of an ACL graft during surgery provides the majority of the strength until the new ACL has started to heal and attach itself to the bone. This usually takes 6-12 weeks and thus, strong fixation is extremely important in the early part of post-op ACL rehabilitation.

The TLS- ACL system has an innovative way of fixing the new ACL graft in place. The ultimate pull-out strength (the force required to dislodge the tape from it's bone fixation) is over 1600N and the ultimate breaking point of the tape-graft construct is 1500N. This compares to around 800N and 1000N for traditional ACL fixation method. TLS have over double the strength of tradional ACL method.


The method of hand-reaming "sockets" inside the knee and then passing the ACL graft from inside to out allows for a very tight press-fit within the aperture of the tunnel. This has been shown to be the area that the majority of healing and integration occurs during the repair process. By making this a tight and circumferential fit, the ACL graft has a secondary fixation other than the tape-screw interface. It also minimizes movement of the graft within the aperture of the tunnel which has been shown to cause widening in traditional fixation methods. It also allows for maximum stable bone-graft contact which should allow the ACL graft to incorporate into the bone potentially much quicker. One of the major factors with early re-injury at around 9 months is the fact that the ACL graft has not revascularized and is essentially still dead tissue. This press-fit security could lead to earlier revascularization. 


  Professor Paul Y F Lee - experience 

Phone : 02032398823

Email : [email protected]

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