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the graph that is taken from the middle
third of the patellar tendon is about 1
centimeters long
it incorporates a plug of bone from the
lower part of the knee cap on one end
and a piece of bone from the upper tibia
on the other end
the defect in the patellar tendon is
closed
the tendon heals and eventually regains
its strength
this graft can also be taken from a
cadaver this has some advantages but
also some risks
the rest of the operation is performed
with the aid of the arthroscope while
viewing the inside of the knee on a
television monitor
the arthroscope is introduced into the
knee and the joint is inspected
any associated problems such as torn
cartilage is corrected
to create a tunnel in the proper
location in the tibia a guide pen is
passed through the upper tibia it enters
the joint at the spot where the ACL
normally attaches to the tibia
the guide pen is over drilled with a
cannulated drill
a guide pin is now passed through the
tibia tunnel and into the femur it is
drilled into the bone at the spot where
the ACL normally attaches to the femur
the pen is over drilled to the
appropriate depth
a long guide pin is now passed upward
through the tibial tunnel across the
joint into the femoral tunnel and out
through the front of the thigh
this guide pen is used to pull the ACL
graft through the tibial tunnel across a
joint and into the femoral tunnel
the knee is fully flexed
working now through a small
in front of the knee a guide pin is
pushed into the femoral tunnel next to
the graft
an interference screw is passed over the
pin and screwed into the femoral tunnel
this secures the upper end of the graft
in the femoral tunnel
the knee is now extended and the graft
is pulled tightly
as tension is applied to the graphed a
second interference screw is screwed
into the tibial tunnel this locks into
place the lower end of the graft within
the tibial tunnel the screws securely
hold the new ACL in place until the bone
plugs heal in place the knee is now
stable and motion can begin immediately
in fact a continuous passive motion
machine or CPM is used to slowly move
the knee about 23 hours a day
this early and continuous motion is very
important to decrease knee pain to
quickly regain knee motion and to avoid
problems with the kneecap