Operation Note

Patient		: Carl Ivan BREWER
Date   		: 29th August 1996
Hospital	: The Avenue
Operation	: Ruptured right ACL, bucket handle tear of right lateral
		  meniscus, full thickness chondral defect of lateral
		  femoral condyte
		  Right arthroscopic hamstring ACL reconstruction, partial
		  lateral menisectomy, chondroplasty of lateral femoral
Surgeon		: Mr Stephen J McMahon
Anaethetist	: Mr David Williams
Assistant	: N/A

The patient had a general anaesthetic. Examination under the anaesthetic confirmed a Grade III medial ligament and a complete rupture of the ACL.

The leg was then prepped and draped in the usual fashion. A high thigh tourniquet was applied for a period of one hour. It was released for 45 minutes and then reapplied for a further 45 minutes.

The knee was firstly arthroscoped. This confirmed the ACL rupture and insubstance tear. He had a full thickness articular cartliage defect on the weight-bearing surface of the lateral femoral condyle measuring approximately 1 x 1cm. The articular cartliage was found to be floating freely within the knee joint and was removed. He also had a bucket handle tear of the body and posterior horn of the lateral meniscus. I resected this tear.

The stump of the ACL was then debrided and the tourniquet released.

Grascilis and semi-tendonosis were harvested through an oblique incision. The medial ligament was repaired using absorbate sutures.

The hamstring graft was prepared by doubling over the two tendons forming a quadruple graft. A 15mm Mitek anchor was attached to the graft using a doubled 5mm Dacron tape.

Drill holes were then made through the tibia and femur and the graft inserted. The tibial end of the graft was attached using a screw and spike washer. The knee was found to move through a full range of movement without any graft excursion or impingement within the notch.

The knee was then irrigated and the wounds closed using absorbate sutures. 20mls of 0.5% Marcain and Adrenalin was instilled within the knee joint. Two drains, one intra-articular and one in the incision where the hamstrings were harvested.

Post-operatively the patient will have routine DVT and antibiotic prophylaxis. He will remain in a hinged knee brace, partially weight-bearing, for a period of six weeks.


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