Ty and I were recently given the fantastic opportunity to observe Kelly Macgroarty in theatre. Kelly is an Orthopaedic surgeon and owner of the Brisbane Knee and Shoulder Clinic. On the day, Kelly performed a total knee replacement, ACL replacement, rotator cuff repair, AC repair and an AC reconstruction. Ty and I found the experience very interesting from a rehabilitation perspective in which it enabled us to see the entry point of the surgery and what structures were disrupted; minor subtleties that can affect the outcome of rehab.
This provided us with a great insight into the complexities of arthroscopic surgeries in contrast to total joint replacements. Interestingly, the arthroscopy procedures took longer to perform than the total joint replacement due to the intrinsic nature of the surgery.
A highlight of the day (besides my little rest in the tea room after seeing the calliper break after attempting to lift the clavicle into position), was the discussion with Kelly after the ACL replacement surgery.
Kelly is a leader in the new ACL repair technique; The Short Graft. This new technique requires taking a graft from the hamstring tendon (semitendinosus) and folding it back on itself four times (in the past, two hamstring tendons were used as a graft). This is then placed on a tensioner and sutured so it forms a single tendon.
The advantages of this technique is that the graft is thicker (9mm as opposed to 7.5-8mm), it is also shorter and stiffer than the grafts used previously. A major benefit from only using one hamstring tendon is the recovery time. With this new technique the patient is walking 4 hours post operation resulting in significantly less quadricep atrophy and an increase in functionality.
Another interesting point Kelly made was the importance of ice and compression post op. He raised a very good question: essentially, the nature of surgery causes acute trauma just like that encountered on a sporting field; therefore why not apply the same RICE protocol?
Dr Macgroarty discussed with Ty and I the differences between the short graft and the LARS tendon graft commonly used in the past for football players. The LARS technique uses an artificial tendon to replace the damaged ACL. The reason this was commonly used in elite sportsmen was because it enabled players to be playing after 3 months post surgery. Sounds amazing right?
The problem however; was that the re-rupture rate was significantly increased. This is due to the fact the LARS tendon is the strongest at the time of insertion and only becomes weaker as it is not a biological tissue. Therefore it does not re-model and adapt to the loads required for sport. Although the short graft technique requires 7-8 months of rehabilitation before athletes return to competitive sport, studies have shown a decrease in re-rupture rates and longevity of the knee mechanics.
The forever improved methods and recent advances in medicine and science is certainly an exciting field. It makes you wonder; what’s next?