January 5, 2015
Written by Martin Susskind (class of 2014-2015)
ACL + Meniscus Repair
Well, I can now say from experience that there is just about nothing in life as “full-circle,” and quite frankly as eerie, as watching a surgery being done on someone else that was just recently done on you. That was my experience during my most recent OREX day; watching an ACL and medial meniscus repair as my own fully rehabbed ACL tingled with something akin to physiological PTSD…
The patient was a 30 year old male who had torn his right ACL and then frayed his medial meniscus because he continued to walk and work on it for 8 months after sustaining the injury. The patient elected to go with an autograft from his patellar ligament (autograft: from his own body instead of a cadaver) which was different from my own surgery in that I had harvested tissue from my hamstring for the ACL reconstruction.
To begin the surgery, the right knee was pumped full of saline to allow for some freedom of movement for the surgeons’ tools. This first step was very interesting to me as I had always wondered how surgeons operated in such a tightly packed part of the body as the knee. The next step was to make a long incision from the top of the patella all the way down to the head of the tibia. The knee opened right up like a zipper pocket to expose the tight white tissue of the patellar ligament which covered the entire surface of the patella. A strip was then cut out of the central third of the ligament that was roughly 10cm in length and 10mm in width. The surgeon literally measured these specs with a mini ruler and marked off his cut parameters with a marker! Sometimes orthopedic surgery is so very like carpentry. A chisel and hammer were then used to excise two “bone plugs” at the top and bottom of the graft (one from the low head of the femur, the other from the top head of the tibia). Once excised, the graft was stretched and tied to a metal apparatus like a clothes line with a wet saline wrap around it to keep it from drying. Finally, the Patellar ligament was stitched back together from the femur-end down to close up the graft excision site… now onto the actual surgical repair…
Three ports are needed for the arthroscopic portion of this surgery and the light on the scope turned the inside of the knee an amazing glowing red. A clipper tool was used to trim the edge of the frayed meniscus (which by the way was VERY frayed). Any fat in the knee was also cut out and sucked up with an amazing tool to increase work space and field of view for the scopes. The Medial side of the meniscus is not vascular tissue so it was excised but the lateral side is vascular and so it was left alone in hopes that it would repair. The frayed edge was meticulously stiched back to the PCL from which it had torn with an awesome “blind-stitch” technique.
The last step of the surgery was to insert the graft into the knee. It’s his new ACL! A small tunnel was drilled into the head of the femur and the head of the tibia and the bone plugs at either end of the graft were hammered into the resulting holes. A tapered plastic drill bit was then screwed into both ends of the graft and left perpendicular to the bone plugs to lock the graft in place. Dr. Guido finished by physically tugging the knee a couple of different directions and was very pleased with the stability fo the graft. The patient can expect a 6-8 month rehab period before he is back to 100% believe me… I would know!
This was such an awesome experience. Once again, I’m a proud OREXer.