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Wheeless' Textbook of Orthopaedics

Positioning and Setup of ACL Reconstruction


- Positioning:
    - options include positioning with the patient supine - flat on the table or
          positioning the patient supine with the knee in a leg holder;
          - supine position:
                  - requires a valgus post, a bump placed under hip, and a bump
                        placed on at the foot of the table to assist w/ knee flexion;
                  - the surgeon can either sit or stand during the procedure;
                       
          - leg holder:
                  - the table is broken to allow full knee flexion (the opposite leg is
                        held with a GYN leg holder);
                  - facilitates the procedure by allowing the surgeon to stand directly
                        in front of the flexed knee (the foot of the table does not
                        get in the way);
                  - it is helpful to have a padded Mayo table which allows the leg to be
                        propped up and extended intermittently during the case;

- Arthroscopic Pump:
    - typically set between 30 and 50 mm pressure;
    - if a pump is used inflation of a tourniquet is usually not required;

- Tourniquet:
    - a tourniquet is placed on proximal thight, but is not used, unless bleeding
            becomes a problem later in the case;





Original Text by Clifford R. Wheeless, III, MD.