New AR Technology Provides Real-Time Guidance During ACL Surgery

In anterior cruciate ligament reconstruction, tunnel malposition is a leading cause of failure, underscoring the need for reliable intraoperative guidance. As digital tools increasingly connect preoperative imaging with real-time navigation, a new system now offers augmented reality-guided, video-based navigation for knee ligament surgery following De Novo classification by the U.S. Food and Drug Administration (FDA)

Smith+Nephew’s TESSA Spatial Surgery System is designed for intra-articular orthopedic procedures. Its first indication for use is femoral anterior cruciate ligament reconstruction (ACLR) of the knee, where femoral malposition (29%) and tibial malposition (11%) are among the most common reasons for failure. The TESSA ( (Tracking Enabled Spatial Surgery Assistant) system aids surgeons with placement and navigation of the femoral tunnel using augmented reality (AR).

The platform uses preoperative magnetic resonance (MR) or computed tomography (CT) scans processed by cloud-based deep‑learning neural network algorithms hosted on Amazon Web Services (AWS) to generate patient‑specific three‑dimensional anatomical models. Powered by NVIDIA artificial intelligence (AI) infrastructure, TESSA overlays the patient‑specific three‑dimensional bone model onto live 4K arthroscopic video. This real‑time, video‑based navigation is intended to unify personalized planning, advanced imaging, and tracking to support intraoperative visualization.

The U.S. FDA granted the system De Novo classification. As part of this action, it is the first device in a new agency category for intra‑articular orthopedic stereotaxic navigation instruments. The classification establishes a regulatory reference point for future devices in this category.

The system leverages technology originally developed by Perceive3D S.A., a spin‑off from the University of Coimbra, which became part of Smith+Nephew through acquisition. It brings personalized planning, augmented reality, advanced imaging, navigation, and real‑time tracking to arthroscopic procedures. The approach is aimed at supporting intra‑articular visualization during surgery.

“Musculoskeletal innovation is entering a new era, where enabling technologies matter just as much as implants. Starting with ACL reconstruction, spatial surgery technology is designed to support surgeon planning and execution, not to replace clinical decision making,” said Dr. Jorge Chahla, Orthopedic Surgeon and Assistant Professor of Orthopedic Surgery at Rush University Medical Center.

“The TESSA System is modernizing ACL surgery by solving an unmet need. It uses computer mapping to help give us accurate tunnel placement – a major problem with current ACL surgery solutions,” said Dr. Anil Ranawat, Chief of the Hip and Knee Division of Sports Medicine at Hospital for Special Surgery in New York.