Anterior Cruciate Ligament Reconstruction - PowerPoint Presentation

Anterior Cruciate Ligament Reconstruction Mardani Kivi M. M.D. Presentation designed for nurses education

What is the Anterior Cruciate Ligament (ACL) ? The ACL is one of the 4 main ligaments of the knee that keeps the knee stable. K N E E A R T H R O S C O P Y

How is the ACL injured Usually injured with a twisting injury to the knee or a direct blow to the outside of the knee with a contact or noncontact mechanism Contact injury Example-hit by an opponent Noncontact injury Example-skiing K N E E A R T H R O S C O P Y

How is the ACL injured K N E E A R T H R O S C O P Y

How is the ACL injured K N E E A R T H R O S C O P Y

Signs and Symptoms of ACL tear Acute Marked pain and pop Significant knee swellingDifficulty bearing weight on the affected kneeChronicThe knee feels loose Feeling of “buckling”, “giving way” or instabilityPain and swelling K N E E A R T H R O S C O P Y

Signs and Symptoms of ACL tear? May also be dependent on injuries to other knee structures Ligaments Medial Collateral Ligament (MCL)Posterior Cruciate Ligament (PCL) Posterolateral CornerMeniscus-(cushions in the knee)Medial Lateral BothArticular cartilage (gliding cartilage on the ends of bones)K N E E A R T H R O S C O P Y

Diagnosis History Physical exam X-rays usually normal but should be obtained to ensure that there is no fractureMRI-excellent for evaluating not only the ACL but also the meniscus, articular cartilage and other knee ligaments K N E E A R T H R O S C O P Y

What is the acute treatment for an ACL tear? Rest Ice ElevationCompressionProtected Weight BearingBrace K N E E A R T H R O S C O P Y

Who does need an ACL reconstruction? Most patients Patients who perform activities requiring an intact ACL-most active patients Patients with associated knee injuriesOther ligaments, meniscus tear, gliding cartilage injuryYoung patients with an otherwise healthy knee No injury to meniscus or gliding cartilage K N E E A R T H R O S C O P Y

ACL dependent activities Dependent Cutting sports Basketball, soccer, football, softball, tennis, cheerleading, skiing etc.High end aerobicsSkateboarding Difficult HikingMost laboring jobsANY ACTIVITY WHEN THE KNEE BUCKLES AFTER THE INJURY Not DependentWalkingJogging in a straight lineDesk jobsRiding a bicycleK N E E A R T H R O S C O P Y

What are the risks of not getting your ACL fixed? Every time patient’s knee buckles he risks injuring other vital structures in his knee Meniscus, ligaments, gliding cartilage What happens if the vital structures are injured?Rapidly accelerated arthritis K N E E A R T H R O S C O P Y

Are there any pre-operative requirements for ACL reconstruction? Yes You should have near normal knee range of motion. Sometimes patients go to physical therapy pre-operatively to get there motion restored before surgery. K N E E A R T H R O S C O P Y

Graft Choices-Autograft Autograft ( patient’s tissue)Bone-Patellar Tendon-BoneBone plug from your knee cap, middle 1/3 of your patellar tendon and bone plug from shin bone Most painfulHamstring autograft 2 hamstring tendonsLess painful than bone patellar tendon bone graftAllows for a very stable kneeGraft of choice for patients with open growth platesK N E E A R T H R O S C O P Y

Graft Choices-Allograft Allograft (cadaver) Least painful Smallest incisionRecommended in patients with significant injuries to other ligaments of the kneeUsually recommended in revision casesVery, very, very small risk of disease transmission from the donor K N E E A R T H R O S C O P Y

K N E E A R T H R O S C O P Y Hamstring Graft

K N E E A R T H R O S C O P Y Hamstring Graft

K N E E A R T H R O S C O P Y Arthroscopy

K N E E A R T H R O S C O P Y Arthroscopy

K N E E A R T H R O S C O P Y Hamstring Graft

K N E E A R T H R O S C O P Y Hamstring Graft

K N E E A R T H R O S C O P Y Arthroscopy (Drilling)

K N E E A R T H R O S C O P Y

Surgery Examination of your knee while you are asleep Fix any associated injuries Torn meniscus Suture repair of meniscus K N E E A R T H R O S C O P Y

Surgery (Meniscus Repair) K N E E A R T H R O S C O P Y

Surgery Reconstruction of the ACL by drilling tunnels (holes) in your femur (thigh bone) and tibia (shin bone) Tunnel (hole) in thigh bone for graft passage ↑ K N E E A R T H R O S C O P Y

Surgery (Drilling and Graft Fix) K N E E A R T H R O S C O P Y

Surgery Passing the graft across the knee and using surgical devices to hold the graft in place while it heals to the bones New ACL graft passed thru tunnels ↑ K N E E A R T H R O S C O P Y

K N E E A R T H R O S C O P Y Graft Fixation Interference Screw Metallic Biodegradable

K N E E A R T H R O S C O P Y Graft Fixation

K N E E A R T H R O S C O P Y