ACL Reconstruction Methods:
The most common reconstruction methods consist of the patella autograft, hamstring autograft and the allograft methods using various cadaver options such as the patella tendon. There are also one or two other reconstruction methods that are being performed successfully as well. There is no ideal reconstruction method. Each method has it's own benefits and disadvantages. Rcmd discuss with your OS for his opinion. Most OS prefer to only perform 1 or 2 of the reconstruction methods. Most patients select from the OS's reconstruction preferences or in some cases, they find another OS to perform a certain reconstruction method.
Patella Autograft reconstruction involves taking 1/3 of your patella tendon. The hamstring autograft is similar.but involves taking a double or quadruple strand of the hamstring as the graft. The allograft reconstructions involve utilizing cadaver (someone else's) body parts.
Pros/Cons (My Opinion)
Patella Autograft - Long track record of success. Very strong. No risk of rejection since it is your own body part. Rehab may take longer due to using your own graft and due to potential to develop patella tendonitis unless aggressive quad exercises are started a little later and very gradual. Graft site location at base of knee cap is sensitive to kneeling generally for up to a year. Some find it sensitive for even a longer period of time.
Hamstring Autograft - The quadruple looping strand method is gaining popularity and is perhaps the strongest reconstruction method. No risk of rejection since it is your own body part. This method is somewhat prone to stretching but overall it is a strong and reliable graft.
Allografts - These are gaining in popularity due to the easier rehab period. Since these do not involve taking a graft from your body, there is no graft site to be concerned about. This reconstructionmethod is not as strong as the other methods but is deemed adequately strong as an ACL replacement. My OS indicated that there was a 1% rejection factor for this method and there is a 1 in a 1 1/2 million chance of contracting HIV. There may have been one case reported in over 10 yrs have reconstructions. Since the muscle recovery is faster on this reconstruction method, the patient must guard against being over confident in his activities before being officially released for sports activities.
Anesthesia:
The most common anesthesia for an ACL surgery is an Epidural, Spinal or General. Each of these could cause some naseau or slight headache as they wear off. Many patients experience no side effects at all. I had the epidural twice and I had no side-effects. In fact, I downed chocolate chip cookies right after the operation !
Epidural - A needle is placed in your lower back and taped down. It is hooked up to an IV. There was no pain associated with this for me. An epidural can allow you to watch the operation. When I had my operation for my partial ACL tear and cartilage tear, I did watch the video screen and it was very interesting ! However, for my reconstruction when I severed my ACL, 8 yrs later, I fell asleep on the way to the surgery room. I think they spiked the IV that was in my wrist and that made me doze off. So, it's possible to get an epidural and either be awake or not be awake for the operation. Discuss with your OS.
Spinal - Is somewhat similar to an Epidural except that they give you a shot in your lower back and that's sufficient for the surgery time period.
General - This is where you are unconscious for the entire operation and awake in the recovery room.
Outpatient Surgery - What Exactly Is It ?
For most knee type deficiencies that require arthroscopy, surgery is performed as an outpatient service. This can mean slightly different things depending on the protocol of your OS and the facility your OS generally performs surgery.
Some patients have the surgery performed in a clinic or a hospital (outpatient wing) and are released the same day. They generally spend some time in a recovery area or room and are then released.
Other patients have surgery in a hospital (outpatient wing), placed in a recovery room and released 23 1/2 hrs later. My insurance company considers outpatient services for periods up to 23 1/2 hrs. I believe they pay more of the cost for outpatient services and then inpatient coverage kicks in. My OS's protocol was to keep me i the hospital for the max 23 1/2 hrs, meaning overnight.
So, what happens in the evening and overnight if staying in the hospital ? Well, the nurses check you out every so often, have you pop some pain killers, take your temperature, give you a meal,.take your temperature, etc. They really like to take your temperature ?
I was mostly comfortable overnight. I had a hospital CPM machine (see the ACL Lingo page for explanation) which was installed by a technician onto my recovery bed and so I played with the CPM remote (starting only a short while after the operation) to increasingly flex my knee and I also played with the tv remote. Luckily, I never confused the two remotes or I would have been in for some ride ! I was released in the morning.
