Picture:Tourniquet on upper thigh
I went in at 7am this morning.
Had the operation at 9:30am.
ACL Hamstring Reconstruction Technique
*Pre-operative antibiotics, +/- regional block
*Supine postion, all bony prominences well padded.
*Anesthesia (GETA / regional)
*Examination under anesthesia.
*Tourniquet placed high on thigh.
*Perform Knee Arthroscopy.
*Hamstring Harvest
*Sartorius, sartorius fascia=superficial and proximal
*Gracilis=rounder, palpable, proximal. Proximal attachment is circumferential, i.e. after harvest you should note muscle fibers coming off both sides of tendon. If only on one side you may have harvested semitendinosis.
*Semitendinosis-flat, larger, broader insertion, difficult to palpate. Muscle fibers only come off one side of tendon proximally.
*3-4cm incision 3 fingers breadths below medial joint line, midline tibial shaft between crests
*Dissection to sartorius fascia, incise fascia just above Gracilis.
*Isolate gracilis, free fascial slips and excise with tendon stripper.
*Right angle clamp to pull semitendinosis into view, isolate, free fascial slips and excise with tendon stripper
*Deeper structure surrounded by fat is saphenous vein and nerve
*Cut grafts to 24cm and prepare on back table with #2 Ethibond whip stitches in each end.
*Debride ACL stump
*Notchplasty
*Tibial tunnel;just lateral to medial tibial spine, 7mm anterior to PCL in posterior half of ACL footprint, along posterior edge of anterior horn of lateral meniscus. Tunnel angled @45 degrees drill/dilate to size
3-4mm offset femoral tunnel guide used to place guide wire in the 11o’clock position for right knee. 1 o’clock=left knee.
*Drill femoral tunnel to 35mm with acorn reamer. Offset <5mm.
Drill endobutton tunnel with endobutton drill. Measure femoral tunnel length.
*Endobutton size = femoral tunnel length – 25mm. Usually 25-45mm. (see Endobutton Technique for full instructions)
*Place a line on the graft 6mm distal to the femoral tunnel length to indicate the point at which the graft is seated deep enough to flip the endobutton.
*Intrafix tibial fastener: make sutures 5” form tibial tunnel and knot corresponding limbs together. Loop sutures over Tie Tensioner. Cylce knee with 30 lbs of tension. *Compress tendons with sheath trial. Insert sheath with derotation lab in 12 o’clock position. Insert screw
*Consider spiked washer and screw tibial fixation augmentation.
*Irrigate.
*SQ closed 2-0 vicryl inverted interrupted
*Skin closed 3-0 monocyl running SQ
*Steri-strips, mastasol, portal sites closed with steri-strips
*Zeroform, 4x4’s, ABD’s, sterile-webril, Ace bandage, cryo-cuff, knee immobilizer locked at 15 degrees.
Picture above: Stripping of gracilis, with firm countertraction to deliver the tendon out of the incision
Picture: The two tendons have been stripped, and will subsequently be detached from their distal insertions.
Picture: The tendons have been sutured together
Orthopedic Surgeon Dr Mark Human.
Recovery afrter anesthetic = good
Femoral Nerve block dont to left leg.
feeling returning from the evening after 8pm.
Omnopon administered for pain via intravenous injection.
Knee Brace locked on 0 Degrees at night.
I sleep on my back.
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