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ACL reconstruction surgery is performed to replace a severely damaged or completely torn ACL with the graft ACL is a thick band of tissue that connects the front end of the tibia to the rear ends of the femur in this procedure an incision is made in front of the knee the graft is taken from the paddler ligaments the one that connects the kneecap to the tibia the incision is closed the rest of the procedure is performed through small incisions with the help of an arthroscope the damaged ACL is removed a channel is drilled diagonally through the tibia and the femur the graft is pulled through the channel special screws are used to secure the graft in place you