simultaneous bilateral acl reconstruction
TRANSCRIPT
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Simultaneous Bilateral ACL Reconstruction:A Safe Option
Saithna A, Arbuthnot J, Radovanovic J, Carey-Smith R, Spalding T
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• Incidence of patients presenting with bilateral ACL deficiency is uncommon
• Simultaneous or staged surgery?
• Published literature
– Jari and Shelbourne, 2002 ( patella tendon autograft, n=28)
– Larson et al, 2004 (patella tendon allograft, n=11)
– Sajovic and Demsar, 2007 (hamstring tendon, n=1)
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Surgeons
Assistant
Mayo table
Scrub nurse
instruments
Stack for left knee surgeon
Anaesthetist
Graft prep
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• ST and Gracilis• 4 strand construct• Femoral Endobutton (Smith and Nephew, UK)• Extralok screw tibia (Linvatec UK)• Linvatec tensioner
• Patella tendon• Ipsilateral central 1/3rd
• Interference fit BioScrews (Linvatec UK)
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Same principle as unilateral surgery
• Cryocuff• Flexion/extension exercises• Mobilise FWB as tolerated• Standardised rehab• No bracing
• Clinical review 2,6,12/52 and then 6 monthly• Prospectively record Tegner, Lysholm
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• 8 patients (6M, 2F)
• Hamstring tendon 7 knees, Patella tendon 9
• Mean age 30.5 yrs (21-41)
• Football(9), Winter sports(5), Fall (2)
• Mean time between injuries 5.2yrs (1-11)
• Mean duration of surgery 104 mins
• 5 patients had meniscal surgery at the same sitting – 3 in both knees
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• Day of discharge; day 1 (6 patients), day 2 (2 patients)
• 2 weeks: – all patients off crutches– All knees > 90 degrees flexion and full extension
• Latest f/u (mean 28 months)– Tegner 5 6.4– Lysholm 61.2 91.2
– Pivot shift Negative 15, Glide 3– Infection 0– VTE 0
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• No compromise in early functional results
• Early FWB then same rehab as for unilateral ACL
• Patella tendon or hamstrings? Patient/surgeon choice
• Small series
• Reduced overall period of rehab and cost
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• A safe option
• Small series – but patients have had no problems
• Reduced period of rehabilitation and reduced cost
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Thank you