ACL Repair


Honey called Rory early the next morning as though nothing had changed in the last month and a half. “Hey Doc, I’m back in town, living above the clinic again. I’m down here in your reception office. Bonnie tells me you’re doing an ACL repair today. I’m ready to help. Are you willing to put me to work?"

“You bet! I've missed you, Honey. Katie said you were back. It was too late to call last night. When do you want me?"

“In an hour. Conrad just dropped Feeney off. I'll show Bonnie how to do this."

"Wonderful. Thanks." What a pleasant surprise to have Honey back, and wanting to start up as soon as she could, Rory though. Now he would need to drop Bonnie's hours back. Hopefully, this job wasn't so important to her that reducing hours wouldn't be a problem. The woman was nice and all, but she was taking too long to catch on to certain things he thought were obvious. He couldn't remember Honey needing such a huge learning curve, but maybe that was his fondness for her showing itself more than real memories. Homey was more inquisitive about things in general, always asking Rory to explain this or that idea. Bonnie never offered herself this way.

"Your hair's different, Honey," was the first thing Rory said after arriving at the office.

"I cut my hair, dyed it black, and straightened it."

"Yep, I knew it was different," Rory agreed."Is this bringing in a whole different person, personality, viewpoint? How much should I be worried about, how did Byron say it, a rabbit suddenly showing up dead in a pot of water on my stove?" He teased Honey, observing her to see if she was over her grief.

She shook her head and smiled easily. "It was my Mom's idea. I needed to become someone else so I could look back at the old person that was so unhappy."

"Did she do the same?"

"No, not this time. She did it a long time ago when my real dad died. It helped her, so she pushed me into it. She was right; it helped a lot."

"How long do you keep this dark look?"

"Until I'm happy again."

"No matter, I'm glad you're back Honey. You make these surgeries almost fun. Let's get the preop going. How many pounds does she weigh?"

"Sixty-three."

After listening to the heart, and running through an anesthetic checklist, Rory figured the dose in the computer and injected the dog.

Everyone was wearing scrubs. This was a big surgery where both Rory and Honey wore gowns along with their hats and masks, not just the scrubs Rory used for minor procedures. Bonnie was anesthesiologist and room nurse.

Feeney was set on the surgery table hooked up to tubes and monitors. Rory and Honey were scrubbing in, next to each other in front of the scrub sink.

“Thanks, Honey,” Rory said as he felt her perform the final tug on his surgery gown. “Oh, that feels so good,” he continued.

“What are you doing inside that gown, Doc?” Bonnie overheard him when she walked back to help.

“I hate starting surgery with my gown crumpled. It gives me a bunched up underwear feeling, but from the outside of my pants.”

“That goes for thongs too,” Honey said. “I don’t wear thongs when I have to assist in surgery. You can’t do anything if you’ve got that wedgie feeling because you have a thong on. Squirming simply seats it deeper.”

“What do you think Doc?” Honey asked as she followed him into surgery.

“I need Bonnie to cut the foot free of the stand so I can finish draping the leg.”

“No, about thongs. What do you think about them?”

“Let me think. I need to organize this first. Bonnie open the stockinet and dump it on my tray. Honey, dig out towel clamps from the pack.”

Bonnie held the foot up so Rory could roll a sterile stockinet to meet the place Honey disinfected with her scrub. After wrapping the foot, he put four towels around the other end of Feeney’s leg, midway between her knee and the femur, the upper leg bone. When he was done, he had a large sterile area of green cloth from behind the dog up to his neck with a stockinet and towel-covered leg sticking from it. Now Rory was able to relax, spread out, work comfortably. And with his arms encased within the gown he could let them settle on the table, something a surgeon cannot do if his arms are bare.

“Scalpel blade please.” He waited with his hands cupped for Bonnie to peel part the foil package, allowing the blade to drop into Rory’s hand without touching it.

He carved an eight-inch line centered on the knee, cutting the inside of the leg. Setting the blade down he picked up the Metzenbaums quickly cutting through the fascia, the silvery white tissue compartmentalizing the muscle groups and tendons. With the fascial attachments cut Rory pushed the skin from the stifle area, giving him good access into the joint capsule. Retrieving his blade, he tapped the joint with his forefinger feeling for a fluid bounce-back, telling him he had located the capsule.

“Ready?” Carefully he pushed the blade through the tissue, waiting for joint fluid to ooze from the cut.

“There it is,” was the indication he found it. “Can you dab the ooze?” He asked Honey. Picking white gauze from the surgery pack she sopped up the escaping bloody synovial fluid.

Digging into his tools, Rory retrieved his Metzenbaums. “To get into the knee joint I have to push the kneecap out of the way, so we need to scissors the joint capsule enough to loosen the knee cap setup.”

“Why?”

“The knee cap lies over the knee joint, the place we need to look at, and we can see inside after doing two things. First, I need to extend the capsular incision to the very top of the joint space. Watch how far above the actual joint the capsule goes,” he showed her. “It surprised me, the first time I saw how it is made, but that’s how we get the extra space to leverage the knee cap out of the way.”