ACL Reconstruction

Bone Patellar Bone

Harvest graft

Make incision centred three fingers breadth below joint line, medial to tibial tubercle
Dissect hamstrings free.
Keep tension with curved clamp, strip soft tissue attachments off prior to using tendon stripper
Keep distal attachment attached & place whip stitches in the two proximal ends
Trim muscle fibres off hamstrings
Place heavy nylon stitch between doubled over tendon ends, & secure this with two vicryl sutures
Release the distal insertion in a lateral direction (to allow later easy transection of the tendons), then place vicryl tuberalizing stitch in distal attachment at some distance from its insertion
Get diathermy & release the tibial tunnel insertion
Place the hamstrings back in the incision

Knee Preparation

lateral portal is more medial, as is the medial portal
stump & lateral wall is debrided
A notch plasty is routinely performed with a small osteotome
insertion point is thoroughly prepared. He aims to have his tunnel 1-2mm anterior to the rear wall

Graft Insertion

tension the graft in full extension

Postop

Full weight bearing next day
One dose of fragmin
No open chain quads