TESSA Spatial ACL Reconstruction Surgery

The ACL is one of the knee’s major stabilizing ligaments. It is commonly injured during activities involving sudden deceleration, pivoting, an awkward landing or direct contact with the knee.

Some ACL injuries can be managed without surgery. Reconstruction may be recommended, however, for athletes and other active patients who experience ongoing instability or want to return to activities that place significant rotational demands on the knee.

During ACL reconstruction, the damaged ligament is replaced with a tissue graft. Dr. Patel creates tunnels in the femur, or thighbone, and tibia, or shinbone, through which the graft is positioned and secured.

Accurate tunnel placement is a critical part of the procedure. The objective is to position the graft so that it reproduces the function of the patient’s natural ACL as closely as possible. A tunnel outside the intended anatomical position can affect graft mechanics and knee stability and may contribute to an unsuccessful reconstruction.

A systematic review and meta-analysis cited by Smith+Nephew identified femoral and tibial tunnel malposition among the common technical causes of ACL reconstruction failure. The TESSA System’s initial application focuses specifically on helping surgeons plan and navigate  tunnel placement.

TESSA stands for Tracking Enabled Spatial Surgery Assistant. The system brings together three-dimensional modeling, artificial intelligence, augmented reality, advanced imaging and real-time navigation within an arthroscopic surgical workflow.

Before surgery, the patient undergoes an MRI or CT scan. Cloud-based deep-learning algorithms use the imaging to create a patient-specific 3D model of the knee’s bony anatomy. Dr. Patel can study this model and plan the intended femoral tunnel position and trajectory based on the individual patient’s anatomy.

During surgery, the system integrates the 3D model with live 4K arthroscopic video. Augmented-reality guidance places relevant planning information over the surgical view, while digitally tracked instruments provide real-time navigational feedback.

The system can be compared to a sophisticated navigation platform: Dr. Patel develops the operative plan and remains in full control of the procedure, while TESSA helps him visualize the planned location and track the instruments used to reach it.

Although knees share the same fundamental structures, anatomy varies from person to person. TESSA allows surgical planning to begin with a model derived from the individual patient’s own imaging rather than a generic representation of the knee.

Potential advantages of the system include:

• Patient-specific planning based on MRI or CT imaging
• Three-dimensional visualization of the patient’s anatomy
• Real-time guidance for femoral tunnel position and trajectory
• Integration of the preoperative plan into the live arthroscopic view
• Immediate navigational feedback during the procedure
• A closer connection between surgical planning and execution

According to Smith+Nephew, surgeons participating in company evaluations reported that the system’s augmented-reality navigation simplified femoral tunnel placement and reduced certain decision-making challenges. These early findings are encouraging, although continued independent research and real-world clinical experience will be needed to determine how the technology affects operative consistency, graft failure, complications and long-term outcomes.

As one of the first surgeons in the country to use TESSA, Dr. Patel will be at the forefront of that developing clinical experience.

TESSA is not an autonomous surgical system, and it does not perform ACL reconstruction independently. It is a planning and navigation platform intended to support the surgeon.

Dr. Patel remains responsible for evaluating the patient, determining whether surgery is appropriate, selecting the graft, creating the operative plan and performing every stage of the reconstruction. The system provides additional visual and navigational information, but it does not replace his training, experience or clinical judgment.

The technology also cannot eliminate every risk associated with ACL reconstruction or guarantee a particular outcome.

TESSA’s current indication concerns tunnel planning and navigation during primary ACL reconstruction. Smith+Nephew has expressed an interest in expanding spatial-surgery technology to other arthroscopic procedures, but those potential applications are separate from its present FDA-classified use.

The FDA’s De Novo pathway is intended for certain novel medical devices that do not have an existing legally marketed predicate device but whose risks can be addressed through general and special regulatory controls.

TESSA’s De Novo classification established both a regulatory pathway and a new category for intra-articular orthopedic stereotaxic navigation instruments. The designation does not mean the system is appropriate for every patient, that ACL reconstruction is free of risk or that the technology guarantees a better result.

Smith+Nephew announced a phased commercial introduction beginning in the third quarter of 2026, with broader deployment anticipated in 2027. Dr. Patel’s early acquisition and use of the system place him among a very small group of U.S. surgeons with access to the technology during its initial introduction.

Advanced navigation may support greater precision during an important part of ACL reconstruction, but the technology used in the operating room is only one factor in a patient’s outcome.

Successful treatment also depends on:

• Selecting the appropriate treatment for the individual patient
• Choosing the right time for surgery
• Selecting an appropriate graft
• Addressing associated meniscus, cartilage or ligament damage
• Applying sound surgical technique and judgment
• Following a structured rehabilitation program
• Restoring strength, mobility and movement control
• Demonstrating physical and psychological readiness before returning to sport

No surgical navigation platform can replace an individualized treatment plan or the patient’s commitment to rehabilitation. Even after a well-executed procedure, recovery takes time. Return to cutting and pivoting sports should be based on rehabilitation progress and objective functional testing—not simply the number of months since surgery.

Patients considering ACL reconstruction may want to ask Dr. Patel:

• Is surgery the best treatment for this injury?
• Which graft does he recommend, and why?
• How does he determine the appropriate tunnel positions?
• Could TESSA navigation be used during the procedure?
• What are the potential benefits and limitations of the technology?
• How might associated meniscus or cartilage damage affect treatment?
• What milestones must be reached before returning to sport?
• What are the risks of reinjury or graft failure?

TESSA represents an important development in personalized, digitally assisted sports medicine surgery. Its ability to connect patient-specific planning with augmented-reality navigation may provide surgeons with an additional tool for addressing one of the technically critical aspects of ACL reconstruction.