Anterior Cruciate Ligament Tears and Their Treatment: arthroscopic and minimally-invasive surgery for ACL reconstruction
Edited By: Christopher J. Wahl, M.D., Suzanne L. Slaney, PA-C, ATC, MMS
Last updated Friday, October 20, 2006
Figure 7 - Arthroscopic view of a right knee. Special instruments are used to remove the residual ACL from the femur and tibia. About the procedureTechnical details (Videos 1, Video 2)
After the patient is comfortably positioned on the
operating table and anesthetic has been administered, the surgeon begins by
examining the knee while the patient is asleep.
During this time the knee muscles are relaxed so the surgeon can assess
the relative stability of the joint, the range of motion, and feel for any
abnormal grinding or catching of the joint.
The knee is then thoroughly washed and draped for surgery.
Next, three very small (1cm) incisions, or “portals” are
made, at the front of the knee. Through
these small incisions specially designed instruments and the arthroscopic
camera can enter the knee. The knee
joint is irrigated with sterile saline which “inflates” the joint with clear
fluid.
The surgeon maneuvers the camera around the joint while he
or she watches a video monitor of what the camera “sees”. A highly skilled surgeon can evaluate all of
the important structures within the joint, test their stability and integrity,
and look for signs of ligament injuries, cartilage wear (or arthritis), and
bony injuries that can be caused by or lead to knee instability or mechanical
grinding. Video 1. Most often, the surgeon will take photographs
of the interior of the joint to help explain to the patient what was found, and
how it was corrected. This portion of
the surgery is called a “diagnostic arthroscopy” and is absolutely necessary to
assure the success of any surgical procedure for knee instability. This is because the arthroscopic examination
of the joint is still the “gold standard”, or best way to understand ALL of the
factors that could be present and may need to be addressed to treat the
problem.
Attention will then be focused on the ACL. The damaged ACL will be removed from the knee
with special small instruments. Figure 7. Depending on the graft used, an incision will
be made to harvest the graft and create the sockets for ACL
reconstruction. The new tissue graft
will be secured into two bone tunnel “sockets” in the femur and tibia so that
it crosses the joint where the injured ligament used to belong. A surgeon who
is comfortable with the anatomy of the joint and who has exceptional skills
with specially designed arthroscopic instruments and implants can perform this
surgery without the need for large incisions in a relatively short time. Other problems in the knee (meniscus tears,
loose bodies, cartilage fragments, etc) can be addressed during the surgery for
ACL reconstruction.
Immediately after the surgery, the patient is placed in a
brace and starts ice therapy. Depending on the surgeon preference and other
procedures performed, the patient can usually leave the hospital on crutches
and weight-bear on the operated leg.
Patients rarely need to spend the night in the hospital after an ACL
reconstruction.
The early postoperative period is devoted to restoring
motion and decreasing swelling in the operated knee. When motion is returning to normal and
swelling is decreased, strengthening is begun and the patient is able to use an
exercise bicycle usually within the first few weeks. By 6-weeks, a more intensive strengthening
program is begun. By 15 to 18 weeks,
when the strength is approximately 80% of the opposite leg, the patient is
allowed to run on even, flat ground.
Agility drills and sport-specific exercises and a cutting program are
started at 20- to 24-weeks, and the patient is generally able to resume cutting
athletics around 6-months. Surgeons
differ as to whether a patient is required to wear a brace after surgery.
During the healing process, the body will organize the
graft and attach it firmly to the bone tunnels.
The tissue will repopulate with living cells. Incorporated grafts achieve their ultimate
strength by about 24 weeks after the operation.Anesthetic There are
two main types of anesthesia: general and regional. In general anesthesia, the patient is
unconscious and has no sensation. A
breathing tube will be inserted to ensure proper breathing. Patients will regain consciousness in the
recovery room at the end of surgery.
Regional
anesthesia (spinal and epidural anesthesia) involves an injection near a group
of nerves between the bones in your back to numb the surgical area. The patient may remain awake or be
sedated. The individual will not see or
feel the actual surgery take place. This type of anesthesia will cause your leg
and knee to be numb not only during the procedure but for several hours after
the procedure.
It is strongly advised, that the patient discuss their
preferences with the surgeon and anesthesiologist prior to surgery. Length of arthroscopic anterior cruciate ligament (acl) reconstruction The procedure takes approximately 1 to 2 hours to
complete. After the procedure, the
patient can expect to spend 1 or 2 hours in the recovery room and anticipate
going home on the same day of surgery.Surgery for Anterior cruciate ligament - ACL - tear at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-543-1552 or 425-646-7777 to make an appointment.
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