Acl Replacement

4 Pages 1098 Words

ACL reconstruction is now essentially an arthroscopic procedure from start to finish, but the exception to this is obtaining the graft tissue itself. In the case of the "bone-patellar tendon-bone auto graft", this requires a 3-5 inch vertical incision in the front of the knee. Other than this skin incision and the incisions in the deeper tissues required to harvest the graft, all the rest of the surgery is done arthroscopically.
Before actually doing the reconstruction, the arthroscope is used to carefully survey the whole joint, looking at and evaluating each key structure. During this portion of the procedure, any additional damage to any of the other knee structures can be identified, and where appropriate, corrected surgically. For example, a torn meniscus cartilage, which occurs 65% of the time in association with an anterior cruciate ligament tear, can be easily identified and resected (menisectomy), or in certain instances, repaired. Some joint surface injuries or roughened areas of the joint can be smoothed with a special "shaver", and loose bodies or fragments of bone or other tissue can be easily removed, although this is fairly rare in these circumstances.
Through the anterior incision, the patellar tendon is exposed just beneath the skin. Once it is harvested, the graft is carefully shaped and prepared for "transplantation" into the appropriate location within the joint. Part of the preparation is the placement of 4 sutures, 2 in each bone block, which will be used to later pass the graft into its proper position and hold it while it is being fixed in place.
Meanwhile, within the joint, the old torn or scarred ACL tissue is trimmed out of the way with a special shaver device. This device which we call a "shaver" is essentially a steel tube revolving inside another steel tube with a window with sharp edges cut in the end of both tubes. Suction is applied through the center of the inner tube, and the combination of the suc...