Arthroscopic setup for ACL reconstruction

Arthroscopic setup is crucial for a safe ACL reconstruction. The aim of this chapter is to describe anesthesiology procedures, prophylactic antibiotics, thromboprophylaxis, patient positioning, instruments, and operating field preparation in this surgery. The most common types of anesthesia are local anesthesia, regional anesthesia, spinal block, epidural block, and peripheral nerve block. Infection is a relatively rare but potentially serious complication after anterior cruciate ligament reconstruction. Antibiotic prophylaxis appears to be the safest way to prevent postsurgical infections. For thromboprophylaxis in clinical practice, different protocols are used, ranging from nothing to low molecular weight heparin in all patients. Patient positioning is a crucial part of surgery, and incorrect placement can result in prolonged surgical times and unexpected complications. The arthroscopic tower is positioned on the opposite site of the operative leg, in front of the surgeon to permit a correct view. ACL reconstruction requires specific surgical devices to perform the correct procedure. A large variety of arthroscopic handheld instruments are commercially available on the market, depending on the desires of each surgeon. Full aseptic precautions must be taken, and the skin should be shaved, and a standard antiseptic solution such as a chlorhexidine-based solution or a povidone-iodine should be applied on the entire leg. Knee arthroscopy requires a draping system that maintains a sterile field throughout the procedure and reliably adheres to the skin to reduce the likelihood of drapes moving over long period of times. Following appropriate positioning and draping, a formal “time-out” is done and the procedure can begin.