ACL Graft choice & anesthesia for surgery
This is part of a series
ACL Graft choice and why
Today I’d like to share which type of graft I chose for my ACL reconstruction, and why. I want to start by sharing my profile as a patient, because it greatly influences graft choice.
Female in her 30s
ACL injury only (no meniscus involvement)
Sports: indoor rock climbing, running
Per my orthopedic surgeon, based on my profile as a patient, any of the grafts could have been appropriate (patella, quadriceps, hamstring, or cadaver)
Graft choice: Allograft (cadaver/donor)
Avoids additional recovery and rehab from taking the graft from another part of your own leg (e.g. having to train your hamstrings to overcome weakness that occurs when taking hamstring graft)
Avoids potential complications from taking a graft from your leg (e.g. chronic anterior knee pain that can occur with the bone-patella tendon-bone graft)
Cadaver/allografts are often cited to have a higher retear risk. This is only true for younger patients (20s and younger) -- I am not part of that demographic, sadly lol. For older patients the retear rate difference is negligible
I do not play cutting sports, which means I am not at high risk for retears anyway. I primarily climb and run. Sports like soccer or basketball represent higher risk because they require quick pivoting.
Anesthesia for ACL surgery
As an anesthetist (CRNA), this is my specialty! So I can speak with first hand knowledge about this part of the journey! I noticed during my Google/Reddit searches that there were often questions about this, so hopefully this is helpful. In the pre-op area, this is what goes on:
A pre-op nurse starts an IV in you
Your surgeon, your operating room nurse, and your anesthesia provider must each check in with you before you go back for surgery
The surgeon will mark your surgical leg
The OR nurse will confirm allergies, any metal in your body, and your consent forms
Your anesthesia provider will discuss the anesthesia plan with you
There is never a "standard" anesthesia plan. There are many parts to it (drugs, method of securing your airway, nerve blocks) and they can each vary depending on factors (your age, existing illnesses, and provider preference).
For a healthy person, here is a very general anesthesia plan, in broad strokes:
Right before surgery
Versed (midazolam) or Precedex (dexmeditomidine) to relax you
The nerve block is placed, if you're getting one
To put you to sleep
Fentanyl or Ketamine to reduce the pain and stimulation of securing your airway next
Lidocaine also to reduce the pain and stimulation of securing your airway next, and also reduces any irritation of propofol in the vein
Propofol to put you to sleep
Once you’re asleep
Insertion of a soft breathing tube into your mouth and throat. This is to manage your breathing during surgery
For the rest of the surgery, anesthesia's job is to maintain/protect your airway, keep you breathing adequately, monitor your heart rate and more... until you're safely delivered to the recovery unit
Again, the above is a loose general template. The finer details will depend on provider preference. “Provider preference” means what your anesthesia provider thinks is best for you. Think about cooking with butter vs. olive oil vs. avocado oil. There are some situations where only one is appropriate. There are some situations where they all work but each has its pros and cons. Your anesthesia provider, based on their expertise and experience, will decide what is best for you :)