Knee repair: standard operating procedure
January 16, 2007
Aspen, CO Colorado
RIFLE, Colo. ” Katy Taylor had the word “yes” written on her left knee as she waited to go into the operating room. Her right knee was covered in what looked to be a white nylon.
“That’s so they don’t fix the wrong leg,” Taylor said.
She had surgery on a torn anterior cruciate ligament (ACL) on Jan. 3, one month and a day after she injured herself. She became unnerved when the anesthetist asked her questions.
“Just make sure you wake me up,” she said with a hint of humor.
She was a little nervous before the procedure, but that’s to be expected from anyone whose only other major surgery consisted of the extraction of her wisdom teeth. This procedure was a little more serious.
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“I try not to focus on it,” she said. “It has to be done.”
Inside the operating room the temperature was set at a steady 69 degrees, the room was bright. and everything was white. Contrary to what television hospital dramas depict, there was no music and the scene was calm and easy. Just another day at the office for orthopedic surgeon Dr. Tom Moore at Grand River Medical Center in Rifle.
“After they’ve recovered, I want to be able to ask the patient which knee was operated on and they should have to think about it,” Moore said.
Moore repairs hundreds of shredded knees every year, due in large part to the ski and snowboard industry.
“Sometimes I think that an archaic orthopedic surgeon must have created skiing for job security,” he said.
He might be right.
The sad truth about skiing is that it produces a considerable amount of injuries to the ACL and the MCL (medial cruciate ligament). However, the PCL (posterior cruciate ligament) that runs crossways behind the ACL in the knee joint isn’t as common an injury in skiing or snowboarding because it’s a more “stout” ligament.
“Both MCL and ACL injuries are fairly common around here,” he said.
The procedure for repairing a torn ACL is fairly simple, but with the advances in arthroscopic surgery the patient has a better chance of a full recovery today than they did 20 years ago.
“Total time should be between three and six months of rehab,” Moore said. “By then, realistically, they could be skiing again.”
Taylor’s surgery lasted only an hour and 40 minutes and was considered an out-patient procedure, so she didn’t even have to stay that night in the hospital.
“It’s really just advanced carpentry,” Moore said.
Basically the surgery breaks down into three parts:
First, Moore makes an incision at the base of the knee joint on the front side of the tibia, or “shin bone.” From there, hamstring tendons from the backside of the knee were extracted and prepared to become the new ACL.
While a physicians assistant threaded the two tendons together, Moore prepared the knee by drilling holes into the bottom of the femur and through the top of the tibia. The new tendon was threaded through the hole in the tibia and into the femur, where it’s held in place with stainless-steel pins. The other end of the new ACL tendon is screwed to the front of the tibia with a spiked washer that holds it tight. Eventually the new ACL will fuse to the bones – stronger than before.
“Statistics show that if the patient injures a knee again,” Moore said. “It’s more likely that they’ll injure the other knee rather than the one that was replaced.”
Taylor has rehab to go through in the coming weeks, but overall she plans on taking it easy.
At least for a while.
“I’m really not going to push it for the first year,” she said. “I’m concerned more with being able to walk and run in the future. Skiing is not the main thing for me, but it will be nice to know that I have the ability to ski again.