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Dr Duong Nguyen MPC

MD, FRCSC, MSc(ClinEpi), DipABOS, DipSportsMed(ABOS), FAAOS, CIME, DipSportMed(CASEM), Adjunct Clinical Professor - McMaster University

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Sports Medicine Surgery

 

 

 


Minimally Invasive, Arthroscopic Assisted,

Anatomical  Anterior Cruciate Ligament (ACL) Reconstruction

(Anteromedial Portal Technique)




Normal Knee Anatomy

 

 




ACL tear with residual stump


 


 





 
















Click on the education links below for more information on your upcoming surgery:

1. ACL Tear in the young female athlete

ACLtearsfemaleathlete.pdf



2. General Information on ACL Reconstruction

http://orthoinfo.aaos.org/topic.cfm?topic=A00549



3. Video Animation of ACL Reconstruction using a Hamstring Autograft

http://content.understand.com/Players/Default/Animation.aspx?PresentationID=b7668aca-1b4a-44c3-aa36-4447f9ffa1cd&Index=5&CustomerID=f0d53a46-95e9-4aee-aaaf-d14d836db183&LanguageID=6574fa28-0a40-49af-88c8-3ce366c8c580



4. Video animation of Sports Medicine surgical techniques

http://www.orthoillustrated.com/




FREQUENTLY ASKED QUESTIONS



1. What is the ACL (Anterior Cruciate Ligament)?


The ACL is one of four main ligaments of the knee that connects the femur to the tibia. The ACL's role is to stabilize your knee during quick start/stop and pivoting/cutting movements. 



2.Do I need ACL surgery?


ACL reconstruction surgery stabilizes your knee and allows athletes to return to sports, especially the ones requiring cutting and pivoting (like soccer, football, rugby, ultimate frisbee, hockey, and basketball)or landing (volleyball, gymnastics, track & field, and skiing)



3. What happens if I don't have ACL surgery?


Athletes who return to play sports or active patients during daily activities are at risk of creating meniscal tears (shock absorbers in your knee)and cartilage defects (lining of your knee) potentially leading to early onset arthritis in the knee.



4. How long is the surgery?


ACL reconstructive surgery typically lasts about 1 hour and a half, depending on whether other procedures need to be performed at the same time (meniscal repair, cartilage repair).


It is an outpatient surgery, which means you get to go home the same day.



5. Is the surgery painful?


Typically, the procedure is well tolerated by most patients. You will see the Anesthesia doctor prior to your surgery to discuss the option of regional anesthesia - freezing of the nerves in your groin, much like freezing when you go to the dentist. This is in addition to your general anesthetic - you go to sleep during the duration of your surgery. 


Dr. Nguyen will also give you a post-surgery folder on the day of the surgery with a prescription for pain medication, anti-inflammatory and antibiotics to take after your procedure.


6. How are the 2 hamstring tendons (gracilis & semitendinosus) harvested?


Through a small incision at the front of the knee. There are 2 remaining hamstring tendons (semimembranosus & biceps femoris) to strengthen during the rehabilitation phase.



6. What happens on the day of the surgery?


Please remember not to eat or drink (even water) after midnight the evening before your surgery.


a. Please arrive 3 hours prior to your surgery.


b. Sign in at the registration desk at the front of the hospital with the registration clerks


c. Go to Day Surgery where the nurses will greet and prepare you for your procedure.


d. The Anesthesia doctor and the operating room nurses will accompany you to the Operating Room


e. Surgery takes about 1 hour and half


f. You will then be transferred to the Post-Anesthetic Care Unit for about 1 hour for observation/monitoring. An X-ray of the your knee will be taken at this time.


g. A porter will transfer you back to Day Surgery to go over discharge details with the nurses for about 1 hour.


They will explain Dr. Nguyen's discharge folder in detail which includes the return appointment date/time (on the business card at the front of the folder), how to contact Dr. Nguyen, discharge instructions and what to expect for the next 10 days after surgery, your prescription for pain medication, antibiotics, and anti-inflammatories, and the rehabilitation protocol to give to your therapist.


h. Unless your had a cartilage repair done at the same time as your ACL reconstruction, you may put weight on your operative leg with the hinge brace locked in full extension. You may use crutches for balance and comfort.


i. Dr. Nguyen will call you the next day to see how you are doing and answer any questions you may have.


j. Dr. Nguyen's Clinical Assistants have given you a return appointment for suture removal 8 days after surgery.


Dr. Nguyen will go over the details of your ACL surgery at that time and show you the arthroscopic pictures of your procedure.




Clinical example of ACL Reconstruction Using Hamstring Autograft











(Photos courtesy of Dr. Freddie Fu)








 

1. Arthroscopic View of Surgical Steps

ANTEROMEDIAL PORTAL FEMORAL TUNNEL DRILLING TECHNIQUE TO CREATE AN ANATOMICAL ACL RECONSTRUCTION


 

 

2.

 

3.

 

 

4.

 

5.

 

 

 

6. 4 strands graft tensioning and non-metal, low profile, intramedullary interference screw fixation with sheath

 

 

 

 

Diagram of femoral fixation technique for an Anatomical ACL Reconstruction. Allows for maximization of femoral socket length which optimizes graft healing

 

 

Post-surgery X-ray of anatomical tunnel position through anteromedial portal drilling & Ziploop femoral fixation device. Tibial fixation is with a PEEK (invisible, nonmetal, nondegradable, inside the bone) Intrafix 4 bundle tensioning fixation screw

 

 

 

 

Post-surgery incisions:

2 small arthroscopy incisions: suture removed 8 days after surgery
1 anteromedial portal incision: suture removed 8 days after surgery
1 harvest/procedure incision (arrow) : dissolvable suture, trimmed 8 days after surgery


 

 

 

 

 

Post-operative Rehabilitation

Click on PDF link below for a copy of Dr. Nguyen's ACL Rehabilitation / Physiotherapy protocol:


DrNguyenKneeACLRehab Protocol.pdf

 

 

Dr. Nguyen's Neuromuscular Training Program (started at 3 months post-surgery in the Sports Medicine clinic)