If surgery is scheduled, the patient must consult an anaesthetist to determine the most appropriate anaesthesia with regard to the patient’s state of health. The anaesthesia will be either general (patient unconscious) or regional (spinal block) where only the lower part of the body is anaesthetised.
The operation takes place in an operating theatre in compliance with strict standards of cleanliness and safety. The patient is placed supine on an operating table and a tourniquet is placed around the thigh.
The main procedure: revision ACL reconstruction
The tendon graft used for this operation depends on the technique used for the primary ACL reconstruction. If the patellar tendon has already been harvested (Kenneth-Jones technique), the hamstring tendons (gracilis and semitendinosus) are used and vice versa.
In the case of reconstruction using the hamstring tendons (gracilis and semitendinosus), the tendon is harvested through a short incision of 2 centimetres on the anterolateral side of the leg, 5 centimetres below the knee.
In the case of reconstruction using the patellar tendon (Kenneth-Jones), the tendon is harvested through a vertical incision of 6 centimetres on the anterior side of the knee. The tendon can sometimes be harvested through two vertical incisions 2-3 centimetres each. The patellar tendon is harvested with two strips of bone, one from the patella and the other from the tibia.
- Technical specificities of the operation
As with the first operation, the revision reconstruction is performed arthroscopically, a minimally invasive surgical technique that enables the operation to be carried out through small incision 5 millimetres in length located on the anterior side of the knee.
This second operation is more complex than the first reconstruction. The main technical difficulty stems from the fact that the bone tunnels in which the previous ligament grafts were attached are not always reusable and so new tunnels need to be created. This is not always possible straight away and in these more difficult cases it is necessary to fill the existing tunnels with a bone graft harvested in the pelvis then, a few months later, create the new tunnels in the correct positions. The tendon graft can then be attached.
Revision ACL reconstruction is often combined with anterolateral ligament (LAL) reconstruction if this was not done during the primary ligament reconstruction. This additional procedure helps improve postoperative knee stability and requires an external incision of 5 centimetres to harvest a band located in the same zone called Fascia Lata of which the harvest is inconsequential.
In addition, any meniscal damage can be treated during the operation. The meniscus is repaired or the damaged part removed.
Before closing up, a drain (Redon) is often inserted in the incision to drain the blood and prevent the formation of a haematoma. This drain is generally removed just before the patient is discharged.
In general, the procedure lasts between 1 hour and 1 hour 30 minutes.
No blood transfusion is necessary for this operation.