Similar to Cardiothoracic surgery where the PA harvests the vein from the leg, the PA is responsible for cleaning up the hamstrings/tendons for ACL reconstructions. Unlike CTS, the PA is not the one harvesting the tendon, but they do have their own side project cleaning it up and stripping the muscle from it.
Typical ACL reconstruction is pretty cool! First the doc marks out where he wants his incisions to be (like any other surgery), then he finds the sartorious fascia where he makes an incision. There are three different hamstrings in the leg: Semitendinosus (Semi-T), Semimembranosus, and biceps femoris. With my doc, two inferior tendons are taken for the reconstruction: the Semi-T and the gracilis which is right next to the Semi-T. The tendon hook shown in the first image is used to isolate the tendon from the leg and release it. Once the tendons are removed, they are stripped of their muscle and whip stitched to allow for manipulation and placement in the joint. In the photo on the right, a boneplug is placed to anchor the tendon into the bone. This is done on each end of the tendon to help secure the newly constructed ACL. The doc then does a manipulation of the joint to make sure it is stable and everything is working appropriately. At flexion of the knee the ACL should have some laxity to it, which is examined for at this time. This part of surgery seems to be unique to Ortho. Manipulation is also parts of other surgeries including some shoulder surgeries.
The patients will take a couple months to get back to walking normally and up to 6 months to start getting back to full exercises. They are sent home on a knee immobilizer and will start progressing slowly through regular visits to ortho and Physical Therapy.
My rotation involves only two days in the OR each week and three in the various clinics that my doctor goes to. The variation makes the time go by pretty fast! However, he sees close to 60 patients a day (if not more), which makes the pace of learning even faster! "Taking the training wheels off" as he said, he started letting me see patients on the first Friday of the rotation. Surprisingly, I picked up the examination for shoulders and knees pretty quickly. Ortho has always been a weak point for me as it involves a lot of memorization! That being said, I am working extra hard this rotation to keep up with his busy schedule.
I think that Ortho involves a lot of anatomy that bases the diagnosis and treatments unlike other specialties that involves more physiology. I find myself studying detailed images of joints daily and attempting to perfect my physical examination of shoulder and knee exams.