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Sports Medicine & ShoulderSpecialist in Gilbert Arizona
Matthew L. Hansen, MD

Matthew L. Hansen, MD

Orthopedic surgeonBoard Certified in Orthopedic SurgeryBoard Certified in Sports Medicine

ACL Vignette

Patient Vignette – ACL Reconstruction

History

PJ.N. is a 51-year-old male. He is a very active person, and has stayed active in personal training, jujitsu and mountain rescue. In November of 2014 he began having pain in his left knee after a jujitsu maneuver, which resulted in immediate pain and swelling. His chief complaint was instability when trying to kick overhead with his right knee with his left knee planted. He also stated he felt uncertain on uneven terrain. J.N. originally saw his primary care provider, who ordered an MRI. When abnormal findings were discovered, he was referred to our clinic.

Clinic Visit #1

J.N. had new X-rays before he was seen by the provider. Even though he had some X-rays done before he came to clinic, more views were ordered to capture all the pertinent information needed for his visit. When the provider entered the room, they started by reviewing the history related to the knee injury. The provider then did a series of exams, including a careful evaluation of both knees, and several maneuvers to test for discomfort to the touch, instability (unstable for ACL tests), range of motion and strength.

X-rays showed no abnormalities of bone or joint space, but did demonstrate swelling in the joint.

ACL XRay Pre AP left
ACI-surgery1-MFC Defect
 ACL MRI Arrows
ACL MRI Arrows

The provider reviewed the diagnosis of ACL tear with the patient. Because J.N. was anxious to avoid surgery, was not struggling with instability on a routine basis, and had not yet attempted to treat his knee non-operatively, he decided to proceed with a trial of physical therapy.

Clinic Visit #3

J.N. attempted approximately 8 months of non-surgical treatment after a second clinic visit, and ultimately decided he was dissatisfied with his level of function. He was concerned that with a new increase in pain and catching in his knee, he would be unsafe during a rescue mission. After a long discussion, including a thorough review of risks and benefits, J.N. decided to proceed with surgery. A new MRI was ordered to evaluate for potential injuries to the knee since the last evaluation.

J.N. was referred to his primary care doctor for physical examination and testing such as a chest X-ray, blood and urine analysis and EKG. This was coordinated by the surgeon’s office, but J.N. was actively involved in insuring all the tests were done in a timely manner.

Pre-Operative Clinic Visit

J.N. followed up one more time in clinic to review the MRI (no new injury!) and all the pre-operative testing, ask questions about the surgery, and purchase the brace for after the surgery. When given the choice of using his patella tendon, hamstring tendon, or a donor graft, he ultimately chose to use a donor graft.

Surgery

For 2 days prior to surgery J.N. used a special soap while showering that decreases the amount of bacteria in the skin. He received a call on the afternoon prior to his surgery with final arrangements and surgery time. J.N. was at the hospital 2 hours before her surgery time to check in to the hospital, start an IV, and sign the requisite paperwork. The surgeon signed his leg, and the anesthesiologist administered a nerve block, which numbed the leg for surgery. J.N. was wheeled off to the operating suite.

Please see more information about details of the surgery itself here and a surgical video here. (coming soon)

ACL Hamstring Repair
ACI-surgery1-MFC Defect
 ACL Hamstring Tear
ACL Hamstring Tear

J.N. was discharged home after less than 2 hours in the recovery room.

After the Surgery

Things happened quickly after J.N. was discharged home. He started therapy within just a few days. He was given exercises to do at home. J.N. recalls taking the pain medication for less than 2 weeks on a regular basis, but would occasionally take a pill prior to therapy. There was a love-hate relationship with the crutches and brace, but he still used them faithfully for the first 6 weeks. (Occasionally the timing varies depending on the choice of graft.)

Post-Operative Clinic Visits

J.N. reported back to the surgeon about 2 weeks postop to have his staples removed. By that time he already felt more stable in his knee than before surgery! New X-rays were taken at 2 weeks, which showed the hardware from surgery (pictured).

ACL Xray Post AP
ACL Xray Post AP
 ACL Xray Postop Lat
ACL Xray Postop Lat

6 weeks after the procedure he weaned use of the crutches. He continued in physical therapy for approximately 3 months, but continues the home exercises he was taught.

How Is She Doing Now?

Today the patient reports he is very happy with his surgical outcome. He has returned to many of his favorite activities, including search and rescue. J.N. reports that he has excellent range of motion, and that his long-standing knee pain has even resolved! While he is anxious to return to many of his prior activities, J.N. has decided he will not return to jujitsu at the same level to avoid further injury. He will, however, remain active in all-terrain search and rescue.

AOSSM AAOS: American Academy of Orthopaedic Surgeons® / American Association of Orthopaedic Surgeons® ORS | Orthopaedic Research Society ARIZONA ORTHOPAEDIC SOCIETY OrthoArizona