A New Era in ACL Surgery: FDA Clears Smith+Nephew’s TESSA Spatial Surgery System

Posted on: August 5th, 2026 by Our Team

On July 29, 2026, the U.S. Food and Drug Administration granted De Novo classification to Smith+Nephew’s TESSA Spatial Surgery System — the first device authorized in an entirely new FDA category for intra-articular orthopedic stereotaxic navigation. In plain terms: for the first time, a surgeon can see a patient’s own three-dimensional anatomy projected directly onto the live arthroscopic view during knee surgery.

I’ve spent my career on procedures where millimeters matter — cartilage restoration, meniscus repair, and ACL reconstruction. TESSA is the most meaningful change to how we execute an ACL reconstruction that I’ve seen in years, and I’m proud to have been one of a small group of surgeons invited to participate in the work supporting its path to FDA authorization. I look forward to bringing it to my patients here in the Chicagoland and Northwest Indiana suburbs.

The problem TESSA is designed to solve

An ACL reconstruction succeeds or fails largely on one thing: where the graft is fixated.

The new ligament is passed through tunnels drilled in the femur (thigh bone) and tibia (shin bone). Those tunnels must reproduce the native footprint of the original ACL. Place the femoral tunnel a few millimeters off and the graft is loaded incorrectly through the arc of motion — it can stretch out, lose tension, restrict motion, or fail outright.

This isn’t a rare or theoretical concern. Published analyses of why ACL reconstructions fail identify femoral tunnel malposition in roughly 29% of cases and tibial malposition in about 11%. Tunnel position is one of the few failure factors that is entirely within the surgeon’s control — which is exactly why it’s worth solving with better technology.

The challenge is that arthroscopy gives us a flat, two-dimensional video image of a three-dimensional joint, viewed through a small camera in a tight space. Experienced surgeons compensate with anatomic landmarks, fluoroscopy, and repetition. TESSA gives us something better: the map itself.

How the TESSA System works

TESSA stands for Tracking Enabled Spatial Surgery Assistant. The workflow has three stages:

1. Personalized planning. Before surgery, your MRI or CT scan is processed by cloud-based deep-learning algorithms that build a patient-specific 3D model of your knee — your notch, your footprint, your anatomy. Not an average knee. Yours.
2. Augmented reality in the operating room. During the procedure, that 3D bone model is overlaid onto the live 4K arthroscopic video in real time. Instead of mentally translating a flat image into three-dimensional space, I can see the reconstructed anatomy registered directly onto what the camera is showing.
3. Real-time navigation and tracking. The system tracks instrument position continuously, assisting with placement and trajectory of the femoral tunnel — the single most common source of technical error in ACL reconstruction.

The underlying computer-vision technology originated with Perceive3D, a spin-off from the University of Coimbra in Portugal that Smith+Nephew acquired, and the platform runs on modern AI infrastructure to deliver navigation fast enough to be useful in a live case.

One point deserves emphasis, and it’s one the developing surgeon group insisted on throughout: TESSA assists the surgeon; it does not replace surgical or clinical judgment. There is no robot drilling your knee. The decisions — graft choice, tunnel position, tensioning, how to handle the meniscus and cartilage findings we discover once we’re inside — remain mine, informed by better information than we’ve ever had intraoperatively.

Why this matters if you’re facing ACL surgery

Most patients understandably focus on graft choice and recovery timeline. Tunnel position rarely comes up in a consultation, yet it is one of the strongest predictors of whether a reconstruction holds up over a lifetime of cutting, pivoting, and landing.

TESSA is designed to improve the accuracy and consistency of that step. For patients, the goals are straightforward:

• A graft positioned to reproduce native ACL biomechanics
• Greater consistency from case to case, including in anatomically difficult knees
• Better tools for revision ACL surgery, where prior tunnels complicate the picture considerably
• Better tools for surgeries that include drilling for multiple ligaments or meniscus root tears.
• Planning that accounts for your specific anatomy before the first incision

The system’s first cleared indication is femoral tunnel placement in ACL reconstruction. Smith+Nephew has indicated that additional arthroscopic applications are anticipated over time — which is why the De Novo classification matters beyond this one device. It establishes the regulatory pathway for an entire category of spatial surgery tools.

Availability

TESSA is being introduced commercially during the third quarter of 2026, with early adopting surgeons and centers first, and broader rollout expected through 2027. I’ll share updates here and on our practice channels as scheduling becomes available at our surgical facilities.

Considering ACL surgery? Let’s talk.

Whether you’re a high school athlete hoping to return for next season, a weekend soccer player, or someone facing a revision after a prior reconstruction that didn’t hold, the right plan starts with a thorough evaluation of your knee, your anatomy, and your goals.

Dr. Ronak M. Patel, MD is a board-certified orthopedic surgeon and fellowship-trained sports medicine specialist serving Hinsdale, Downers Grove, and the greater Chicagoland and Northwest Indiana area, with a practice focused on joint preservation, cartilage restoration, and ligament reconstruction.