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Hamstring graft preparation using fibre loop arthrex

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Graft Preparation utilizing #2 FiberLoop® and the SuperSpeedWhip™ Technique

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Anterior cruciate ligament (ACL) reconstruction patellar tendon is a surgical procedure that replaces the injured ACL with a patellar tendon. Anterior cruciate ligament is one of the four major ligaments of the knee that connects the femur (thigh bone) to the tibia (shin bone) and helps stabilize…

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ACL-An ACL injury is a tear or sprain of the anterior cruciate (KROO-she-ate) ligament (ACL) one of the strong bands of tissue that help connect your thigh bone (femur) to your shinbone (tibia). ACL injuries most commonly occur during sports that involve sudden stops or changes in direction, jumping and landing such as soccer, basketball, football and downhill skiing.
Many people hear a pop or feel a "popping" sensation in the knee when an ACL injury occurs. Your knee may swell, feel unstable and become too painful to bear weight.
Depending on the severity of your ACL injury, treatment may include rest and rehabilitation exercises to help you regain strength and stability, or surgery to replace the torn ligament followed by rehabilitation. A proper training program may help reduce the risk of an ACL injury.
BCIS-Bone cement implantation syndrome (BCIS) is a potentially fatal complication of orthopedic surgeries that use cement. The symptoms of BCIS occur primarily during femoral fracture repairs, but this complication has been reported in a wide variety of cemented procedures.

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https://www.bjanaesthesia.org.uk/article/S0007-0912(17)34064-3/pdf

Bone cement implantation syndrome (BCIS) is characterized by a number of clinical features that may include hypoxia, hypotension, cardiac arrhythmias, increased pulmonary vascular resistance (PVR) and cardiac arrest.

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Vendor ACL Reconstruction set

Own set:
Power tools
Ortho basic set
Arthroscopic set (Trocar and lens)
Arthroscopy hand instrument (Punch/ suture retriever)
Drapes and consumable

Equipment:
Arthroscopy tower (TV monitor)
Tourniquet
Side support
Leg holder

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Bone cement implantation syndrome (BCIS) is characterized by hypoxia, hypotension, cardiac arrhythmias, increased pulmonary vascular resistance and cardiac arrest. It is a known cause of morbidity and mortality in patients undergoing cemented orthopaedic surgeries. Surgical risk reduction strategies for BCIS include medullary lavage, good hemostasis before cement insertion, minimizing length of prosthesis, using non-cemented prosthesis and venting the medulla.[4] Venting the medulla permits air to escape from the end of the cement plug and reduces the air embolus.
ACL: Ligaments are strong bands of tissue that attach one bone to another bone. During ACL reconstruction, the torn ligament is removed and replaced with a band of tissue that usually connects muscle to bone (tendon). The graft tendon is taken from another part of the knee or from a deceased donor.

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Bone cement is the gold standard on joint operation used along with advent press fit implants. However have some negative effect such as toxicity related to bone cement

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ACL operation information for patients

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One of the most popular operations in sports medicine is anterior cruciate ligament (ACL) reconstruction. There are several areas of contention in ACL tear therapy that have involved surgeons and researchers in arguments to determine the best approach for these patients.

In patients who want to resume their pre-injury activity level, surgical therapy of ACL tears looks to be the answer. The timing of reconstruction and rehabilitation is critical for a successful outcome. Each type of graft has distinct advantages and disadvantages; consequently, careful graft selection for each patient is critical.

Open stripper

Calibration plate

Rigid, accurate and one-hand use tibia guide

Femoral guide (aimer) with an offset of 1mm to 3 mm allowing optimizing the femoral tunnel location with hamstring tendon reconstruction technique

Two eye-looped guide pins of Ø2.4mm Canulated drills and reamers Two guide pin of Ø1.2mm for the placement of the EUROSCREW®

Conformator set for helping the 🤬 when hard bone is encountered  or EUROSCREW® NG screwdriver ADVANTAGES Optimum adaptability Functional Resterilisable Simple to use

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AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website.

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ACL Reconstruction Animation - OrthoInfo -AAOS

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AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website.

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Bone cement implantation syndrome (BCIS) is characterized by hypoxia, hypotension, cardiac arrhythmias, increased pulmonary vascular resistance and cardiac arrest. It is a known cause of morbidity and mortality in patients undergoing cemented orthopaedic surgeries. T

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When the anterior cruciate ligament (ACL) in the knee is torn or injured, surgery may be needed to replace it. There are many different ways to do this operation. One is to take a piece of the hamstring tendon from behind the knee and use it in place of the torn ligament. When arranged into three or four strips, the hamstring graft is a very strong graft for reconstructing the ACL.

Most surgeons perform this surgery using an arthroscope, a small fiber-optic TV camera that is used to see and operate inside the joint. Only small incisions are needed during arthroscopy for this procedure.

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Bone Cement Implantation Syndrome

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ACL
ACL reconstruction is surgery to replace a torn anterior cruciate (KROO-she-ate) ligament (ACL) — a major ligament in your knee. ACL injuries most commonly occur during sports that involve sudden stops and changes in direction — such as soccer, football, basketball and volleyball.

Ligaments are strong bands of tissue that attach one bone to another bone. During ACL reconstruction, the torn ligament is removed and replaced with a band of tissue that usually connects muscle to bone (tendon). The graft tendon is taken from another part of your knee or from a deceased donor.

ACL reconstruction is an outpatient surgery that's performed by a doctor who specializes in surgical procedures of the bones and joints (orthopedic surgeon).

BCIS - Bone cement implantation syndrome

BCIS is characterized by hypoxia, hypotension or both and/or unexpected loss of consciousness occurring around the time of cementation, prosthesis insertion, reduction of the joint or, occasionally, limb tourniquet deflation in a patient undergoing cemented bone surgery.

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1.     Bone Cement Implantation Syndrome (BCIS) is a potentially fatal complication of orthopaedic surgery, involving pressurised bone cement. BCIS is characterised by hypoxia and/or hypotension (with potential loss of consciousness), occurring around the time of bone cementation.

That’s why when putting with cement, it is very important to alert the anaesthetist an AU nurse to closely monitor the patient and detect abnormal symptoms early.

Clinical features consistent with BCIS: Hypoxia, Sudden loss of arterial pressure, Pulmonary hypertension, Arrhythmias, Loss of consciousness, Cardiac arrest.

2.      ACL: The anterior cruciate ligament (ACL) is one of the main stabilising ligaments in the knee, connecting the thighbone (femur) to the shinbone (tibia). An anterior cruciate ligament injury is commonly called an ACL tear. ACL tears are more likely to happen when you abruptly stop or change direction, or when you land awkwardly.

https://www.youtube.com/watch?v=q96M0jRqn7k

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Bone cement implantation syndrome (BCIS) is a rare and potentially fatal perioperative complication of cemented bone surgery. Clinically, it can be as benign as transient desaturation or mild hypotension.
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ACL reconstruction surgery using hamstring. What are the equipment required for this procedure. Put you discussion by adding your comment, you can also share with videos, pics or articles.

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Detailed video of Arthroscopic ACL Reconstruction using four stranded hamstring graft

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Sir,

Bone cement implantation syndrome (BCIS) is characterized by hypoxia, hypotension or both and/or unexpected loss of consciousness occurring around the time of cementation, prosthesis insertion, reduction of the joint or, occasionally, limb tourniquet deflation in a patient undergoing cemented bone surgery.[ 1]

The following case report describes a cardiac arrest in a patient undergoing a cemented hemiarthroplasty. This report provides further clinical evidence of the risks and consequences of fat embolization during hip arthroplasty surgery. Data concerning the fatalities of BCIS is sporadic and rare, so more and more reporting of data may help in understanding the condition better.

A 68-year-old male patient was admitted to our hospital with history of fracture neck of femur left. He had history of fall one day ago. Patient was dyspnoeic at rest (Grade IV) on admission. On evaluation, he was found to have fibrosis of the left upper lung with collapse of the left lower zone. He was a chronic smoker. Other medical history included hypertension since six years and bronchial asthma since six years, on irregular medication; old Pulmonary Koch's which was irregularly treated 20 years ago. ECG Electrocardiogram showed premature ventricular ectopics. On admission, patient was stabilized with anti-hypertensive medications, anti-asthma medications and oxygen. Active Koch's was ruled out. After five days of treatment the patient felt symptomatically better, and it was decided to operate the patient for Austin Moore prosthesis (hemiarthroplasty).

On the day of surgery, the patient was conscious and coherent, with a pulse rate of 92/ min, blood pressure of 150/90 mm hg in supine position, respiratory rate was 22 and patient was not dyspnoeic. His cardiac examination was normal while respiratory examination showed decreased breath sounds on the left side; there were no adventitious sounds on either side. His investigation revealed hemoglobin of 9.8 g%, blood sugar of 117 mg/dl, blood urea of 50 mg/dl and serum creatinine of 1.9 mg/dl.

Patient was taken onto the operation table and monitors (pulse oximetry, NIBP non invasive blood pressure and electrocardiogram monitors) were applied. In view of the respiratory condition of the patient, it was decided to proceed with regional anesthesia (epidural). Under all aseptic precautions, epidural space was identified with loss of resistance technique with 16-gauge tuhoy needle at 6 cm from the skin, 18-gauge epidural catheters were inserted and fixed at 9 cm from the skin at the L2- L3 level. Injection Ropivacaine 0.75% 10 ml was given in titrated doses. After 15 min, adequate anesthesia (T10) level was obtained. The patient's blood pressure dropped to 130/80 mm of hg with NIBP and pulse rate was 84/ min and respiratory rate was 20/min. Patient was put on oxygen supplementation of 5 lit/min with face mask. Lateral position was given. Blood pressure was 130/84 mm hg and pulse rate 82/ min, respiratory rate was 20/ min after painting and draping procedure was started. The hemodynamics and respiration was normal during the procedure. After 45 min of surgery, medullary reaming was completed and bone cement (surgical simplex P, stryker) was applied. On application of bone cement, patient developed sudden bradycardia, with a heart rate of 20/ min, peripheral pulses were not felt, blood pressure was not recordable with NIBP. Patient became apnoeic and unconscious. Immediately, endotracheal intubation was done in lateral position with 7.5-mm portex endotracheal tube. Wound was packed and patient was shifted to supine position. Patient was ventilated with 100% oxygen, and effective cardiac compression started. Intravenousfluids were started; injection adrenaline 1 mg (1:1000) was given Intravenous, injection atropine 0.6 mg (1:1000) given and external cardiac compression started. After five cycles of cardiopulmonary resuscitation pulses were palpable and heart rate was 130/min, it was a sinus rhythm. Systolic blood pressure was recorded as 90 mm Hg. Intravenous fluids were continued to maintain preload along with inj dopamine 10 mcg/kg/min. Surgical closure was done and patient was shifted to acute medical care unit with life support.

In AMC, patient was put on ventilator, with dopamine support (10 mcg/kg/min) to maintain blood pressure around 100 mm Hg systolic and internal jugular catheterization was done to assess central venous pressure (CVP), which was around 12 cm throughout the period. Fluids were guided by CVP. Arterial blood gases and chest X-ray revealed no additional findings. Patient did not regain consciousness.

After eight hours of surgery, patient developed sudden pulseless electric activity, CPR was initiated including external cardiac compressions and injection atropine 0.6 mg IV and injection adrenaline 1 mg (1:1000); they were repeated every 3 min till three doses. Patient could not be revived after one hour of resuscitation.

Patient's relatives did not consent for necropsy.

DISCUSSION

Bone cement is an acrylic substance used to secure implants to bone or to fill joint cavity. Bone cement is a filler and not an adhesive. The contents include methylmethacrylate monomer, a colorless flammable liquid, barium sulphate added to make cement radio-opaque, and polymer component - a white powder and benzyl peroxide.

Bone cement implantation syndrome is now an established entity, though there is no widely accepted definition to it. The cases range from a mild form like transient hypoxemia to a fatal form including death.

Severity classification of BCIS is as under:[ 1]

Grade 1: moderate hypoxia (SpO ² <94%) or hypotension [fall in systolic blood pressure (SBP) >20%]

Grade 2: severe hypoxia (SpO ² <88%) or hypotension (fall in SBP >40%) or unexpected loss of consciousness.

Grade 3: cardiovascular collapse requiring CPR.

The incidence of BCIS varies widely in the literature and fatalities have been rare. In India two fatalities have been reported from Max Hospital, Delhi.[ 2] The etiology and pathophysiology of BCIS has not been completely understood. Various theories have been proposed including release of polymethyl methacrylate monomer into circulation during cementation.; recent studies focus on emboli formed during cementation and resultant right ventricular failure.

Embolization occurs as a result of high intramedullary pressures developing between cement and prosthesis insertion. The cement undergoes an exothermic reaction and expands between the space of the bone and prosthesis trapping air and medullary contents under pressure. The temperature of cement can increase up to 96 degrees centigrade. When prosthesis is put, the contents escape into the interstices of bone because of already developed intramedullary hypertension. This leads to embolization. Knowing that the extent of embolization is proportional to the intramedullary pressure.

The debris from the medulla can embolize to the lungs and heart. It is the shower of pulmonary emboli that result in characteristic circulatory changes leading to hypoxia and right ventricular dysfunction, though the degree of cardiovascular collapse is not proportional to the degree of embolization.

Numerous patient-related risk factors have been implicated in the genesis of BCIS including old age, poor preexisting physical reserve, impaired cardiopulmonary function, preexisting pulmonary hypertension, osteoporosis, bony metastases, and concomitant hip fractures, particularly pathological or intertrochanteric fractures.[ 1]

Surgical risk factors include previous uninstrumented femoral canal, and use of long-stem femoral component.[ 1]

Anesthetic risk for BCIS can be reduced by meticulous preoperative examination to rule out significant cardiac, pulmonary or metastatic bone diseases, complete investigation of the patient's co-morbid diseases and careful pre-optimization of the patients. Increasing the inspired concentration of oxygen should be considered at the time of cementation.[ 3] Hemodynamic monitoring should be considered for all cases that are particularly at risk for BCIS.[ 3]

Surgical risk reduction strategies for BCIS include medullary lavage, good hemostasis before cement insertion, minimizing length of prosthesis, using non-cemented prosthesis and venting the medulla.[ 4] Venting the medulla permits air to escape from the end of the cement plug and reduces the air embolus.

A fall in end-tidal carbon dioxide concentration can be the first sign of the embolism and should alert the anesthesiologist. In awake patients, first symptoms may include dyspnoea and altered sensorium.[ 5] If there is an evidence of BCIS, inspired oxygen concentration should be 100%, and it should be continued in the postoperative period. The hemodynamic collapse of the BCIS should be treated on the lines of right ventricular failure.[ 6] Aggressive resuscitation with IV fluids has been recommended.[ 2]

Choice of vasopressor is generally sympathetic alpha 1 agonist in view of the right heart failure and vasodilatation.

In our case as mentioned above, the patient was a high-risk candidate for BCIS as he was an elderly patient having severe cardiopulmonary disease with decreased functional reserve (age 68 years, pulmonary fibrosis, bronchial asthma and systemic hypertension, old pulmonary Koch′s). Immediately after putting bone cement, patient developed sudden bradycardia hypotension, and unconsciousness. Patient was resuscitated with endotracheal intubation and ventilation with 100% oxygen supplementation, effective cardiac compression, and injection adrenaline. Patient revived after five cycles of CPR, fluids were loaded and patient was treated on the lines of right ventricular failure. Patient developed pulseless electric activity after eight hours of surgery and could not be revived. This was Grade III bone cement implantation syndrome, despite our best efforts we could not revive the patient.

So, in conclusion, we should take extra precaution while using bone cement in patients with co-morbid diseases, increase inspired oxygen concentration while using bone cement, and keep a close vigil on the patient's hemodynamic status during and after use of bone cement to prevent unexpected fatalities; "detect early and act fast" to save the patient.

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Bone cement implantation syndrome: A rare catastrophe

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Sir, Bone cement implantation syndrome (BCIS) is characterized by hypoxia, hypotension or both and/or unexpected loss of consciousness occurring around the time of cementation, prosthesis insertion, reduction of the joint or, occasionally, limb tourniquet deflation in a patient undergoing cemented bone surgery.[ 1] The following case report describes a cardiac arrest in a patient undergoing a cemented hemiarthroplasty.

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