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tears of the anterior cruciate ligaments are most commonly caused by having the upper leg displaced backwards or sideways by impact while the lower leg is in the stable position reconstruction of the anterior cruciate ligament is required to restore its function following damage to it the ligament itself cannot be repaired and so a replacement is typically grafted a patellar tendon graft involves the removal of the middle section of the patellar tendon along with attached plosive bone on each end a single tunnel into the tibial and fibular bones is made the damage ligament is extracted and the replacement ligament is brought through the bones sometimes being secured by screws