Hamstring tendon graft for anterior cruciate ligament reconstruction - Home Study Program

AORN Journal,  Oct, 2002  by Deborah M. Boni,  George E. Herriott

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Many patients who undergo ACL reconstruction are excellent candidates for patient controlled analgesia for 24 to 48 hours postoperatively. Oral pain medication usually is effective after this time.

Upon arrival in the medical-surgical unit, the assigned nurse measures the patient's vital signs and peripheral circulation every 15 minutes for one hour. The nurse continues to monitor the patient every hour until discharged.

Discharge instructions. The nurse explains possible adverse reactions that may occur, including swelling, burning, tingling, loss of sensation, and excessive bleeding. He or she also tells the patient who, when, and what numbers to call during both normal and after office hours in the event that the patient has questions or concerns. The nurse also instructs the patient to

* elevate the surgical leg and use ice for 48 hours to minimize swelling and pain;

* use crutches to avoid weight bearing on the surgical leg for approximately two weeks;

* not stand for long periods of time;

* bathe by placing a dry towel around the surgical limb covered by a clean garbage bag taped just above the dressing; and

* not drive for 72 hours.

Physical therapy. Before the patient is discharged, a physical therapist fits the patient with crutches and gives instructions regarding their correct use. If the patient must use stairs, the physical therapist instructs him or her on a safe method of climbing and descending stairs using crutches. The therapist instructs the patient regarding early quadriceps muscle strengthening exercises to be performed for the first two postoperative weeks. These exercises include

* straight leg raises,

* quadriceps sets in which the patient locks the quadriceps muscle until the back of his or her knee touches the bed, and

* heel slides in which the knee is flexed to 90 degrees.

The physical therapist also instructs the patient to maintain the brace at zero degrees flexion while ambulating during the first two weeks.

Follow-up physician visit. The patient returns to the surgeon's office two weeks after surgery for a wound check. The surgeon then instructs the patient to continue wearing the brace while beginning to bear full weight on the surgical leg.

CONCLUSION

This article discusses the use of hamstring tendon graft for ACL reconstruction. Several research studies have been performed comparing the use of a hamstring tendon graft verses a patella tendon graft. These studies demonstrate that even though both techniques result in a stable, functional knee, patients on whom hamstring grafts were used had less postoperative pain and a quicker return of quadriceps muscle function. One such study demonstrates that the advantages of using the hamstring tendon graft include

* the graft is larger and stronger than a patellar tendon graft,

* morbidity of the harvest technique donor site is less than that of patellar tendon grafts,

* there is little quadriceps inhibition after quadriceps harvest, and

* there is quicker return to sports activities after aggressive rehabilitation. (9)