ACL Reconstruction Step by Step
ACL RECONSTRUCTION STEP BY STEP
by Orange County Knee Specialist Dr. Mora
This is an MRI image showing the ACL rupture and blood in the knee.Surgery is usually performed after the acute symptoms of the ACL tear have diminished.It is important to have as much range of motion prior to surgery.
The arthroscopic view of the notch.The ACL is ruptured. The torn fibers have been re absorbed.
The Notchplasty: In the past this was a significant part of the procedure.Currently the amount of bone removed is minimal.The graft is placedanatomically therefore impingement is not as common.
A bone tunnel is made above and below. This is the tibial tunnel.
In the past the femoral tunnel was placed more vertical. Current thought is that the tunnelshould be more anatomical.I use flexible reaming tools that allow me to place the graftin lower position which is thought to improve rotational stability.
Passage of the new ACL graft by using the sutures tied to the end of the top bone plug.
The graft is about to be passed. The suture holding the graft is visible as it is pulled upward.
Insertion of the 2 screws. These will dissolve and will become replaced withbone after approximately 2 years.
New ACL Graft in place within the tunnel above and below.Next are the screws which act as threaded dowels squeezing the graft against the tunnel walls.More recently I have been using bio composite screws.Biocomposite screws are composed of a calcium type of substance.Femoral screw going in.
New ACL graft is secured into the femoral and tibialtunnel with the screws. Prior to completing the surgery I confirm that the knee
has full motion, check for impingement and confirm screw position.
Once surgery is complete I close the incisions with absorbable sutures and or Dermabond. The knee is wrapped with an ace wrap. A immobilizer and the cold therapy unit are applied.
PRE AND POST OP CONSIDERATIONS
Anterior Cruciate Ligament Surgery is done under general anesthesia. A femoral nerve block can also be performed. The nerve block helps with post op pain control.Pre and Post Op Care
My graft options from Dr. Mora will include your own patella tendon (autograft) or a cadaver patella tendon graft (allograft). If you would like to know more about allografts please go to my blog article.
The procedure lasts approximately 1.5 hours.
After the surgery you will stay in the recovery room approximately 1-1.5 hours.
You will have a brace and crutches. Both must be used for ambulation after the procedure.
You can apply weight to the operated leg unless indicated otherwise. You will be given a post operative exercise guide. They are very basic and include straight leg raises, quad sets and heel slides. These exercises are safe to do any time after surgery.
A pain medication and a antibiotic are prescribed after surgery. These prescriptions are given to you on your pre operative visit. I usually prescribe Norco and Keflex.
When you are home after surgery plan on resting and elevating your leg. Although you are allowed to apply weight to your leg you should try to keep it at a minimum especially the first 3 days after surgery.
You will see me for a post operative check approximately 1 week after surgery.
Red Flags: An elevated temperature over 101 is not expected. The skin color around the incisions may look bruised and swollen but it should not look red. A post op infection looks like a severe sun burn. If you have any of these signs see me prior to the scheduled post operative visit.
Post operative pain control is very important. I highly recommend a cold therapy unit. A vendor will provide you the details regarding insurance coverage and out of pocket expense. These units are usually not covered by private insurance. You can augment the pain medication with an over the counter anti inflammatory such as Aleve, Motrin, Ibuprofen, etc. You may also want to have a over the counter sleeping medication such as Benadryl 50 mg to take at night as needed for insomnia.Please remember that the more narcotics (Norco, Vicodin) you take the higher the chance for nausea and constipation.Minimizing swelling by elevating your leg is very important.
I will prescribe post operative physical therapy after I see you for your first post operative visit.
Return to work: If you work in an office and can return to work with crutches I would recommend you take a couple of weeks off. If you have a stand up job that requires walking but not heavy lifting or ladders I think you may be ok to return after 6 weeks. If you have a highly physical job such that requires running and very heavy lifting, you might be ok to return after 4 months.
Recovery and return to sports depends on various factors. In general patients are usually not cleared for high level competitive pivoting sports for 6-9 months. Patients who have allograft should wait a little longer to decrease the risk of re rupture.
And now its off to the races……
Good luck with your surgery. Please let me know if I can answer any questions.
About Steve A. Mora MD:
Dr. Mora is a native of Orange County. He graduated from Anaheim High School in Orange County CA. He completed his training at the UC Irvine where he earned top of his class honors with his induction into the Alpha Omega Alapha Medical Society honors. He completed his Orthopedic Surgery training USC. He then completed a Sports Medicine, Cartilage, Shoulder, and Knee Fellowship at Santa Monica Orthopaedic and Sports Medical Group. He is currently practicing Orthopedic Surgery in Orange County. Dr. Mora’s practice focus on sports related trauma, knee ligament and cartilage repair, shoulder rotator cuff and instability, hip arthroscopy and partial knee replacement and ACL reconsctruction. He sees athletes of all levels including professional soccer and UFC/MMA. He is team doctor for the Anaheim Bolts pro indoor soccer team and Foothill High School. Some of the procedures he performs include Cartilage transplantation (Genzyme), partial custom knee replacement, OATS, tibial osteotomies, meniscus transplant, knee ligament reconstruction, shoulder reconstruction, elbow arthroscopy, hip arthroscopy, platelet rich plasma and adult stem cell injections. Dr. Mora’s family heritage is Peruvian. He speaks fluent Spanish.
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Restore Orthopedics and Spine Center
112o W. La Veta Ave, Third Floor
Orange, CA 92868
Office: (714) 598-1745
Fax: (714) 941-9539