This research introduces a novel method for administering local anaesthesia along the hamstring graft harvest tract to alleviate postoperative pain following anterior cruciate ligament (ACL) reconstruction. The technique is a significant advancement in pain management, designed to provide targeted pain relief that is a key factor in improving patient comfort and accelerating recovery outcomes after ACL surgery. The approach directly addresses a common source of discomfort that can hinder the early stages of a patient’s rehabilitation journey.
The Clinical Challenge of Donor Site Pain
Postoperative pain following ACL reconstruction is a complex, multi-faceted issue. Discomfort originates not only from the operated joint but also from the extra-articular donor site where the autograft tendons were harvested. While the knee joint is often the primary focus of pain management, the localised pain and swelling at the
hamstring graft harvest site can be a major obstacle to a successful recovery. Rehabilitation protocols often instruct patients to “avoid activities that produce pain at graft donor site” , which creates a challenging paradox for physical therapists. Pain in this area can interfere with essential, early-phase exercises and limit a patient’s ability to achieve a proper, pain-free gait. The inability to activate the hamstrings without discomfort can disrupt proper movement patterns and delay the progression of a physical therapy regimen. Current pain management strategies, such as generalised regional nerve blocks, may not adequately address this specific, localised source of discomfort, highlighting a significant therapeutic gap in standard post-operative care.
A Detailed Look at the Procedure
The technique detailed in this research presents a precise solution to the problem of donor site pain. This innovative method is an elegant example of innovation through the repurposing of existing surgical tools. Rather than requiring complex or costly new hardware, the procedure utilises a standard surgical suction catheter and a femoral tunnel depth gauge, making it easily replicable across various clinical settings. The technique involves using a trimmed Kendall Argyle™ suction catheter, stabilized with a femoral tunnel depth gauge, inserted along the path of the harvested hamstring tendons. This ensures the anaesthetic will be delivered to the exact location of the surgical site. A single bolus of 62.5 mg bupivacaine, diluted to 50 ml with normal saline, is injected as the catheter is withdrawn. The dilution to a 50 ml volume ensures the solution permeates the entire tissue plane of the harvest tract, maximising the analgesic effect and providing targeted relief to the source of the pain. The entire procedure is quick and can be performed at the conclusion of the main surgical reconstruction, adding minimal time to the overall operation.
Clinical Impact and Patient Benefits
The primary clinical advantage of this novel technique is its ability to provide highly targeted and effective analgesia precisely where the pain originates. By delivering a long-acting anaesthetic directly to the hamstring harvest tract, it addresses a source of discomfort that is often resistant to conventional pain management protocols. This targeted approach can have a substantial ripple effect on a patient’s recovery. By effectively managing the most intense and functionally limiting pain, the technique has the potential to significantly reduce the patient’s dependence on systemic opioid medications. This reduction in narcotic use is a key objective of modern pain management, as it minimises the risk of opioid-related side effects such as constipation and sedation. Furthermore, effective pain control acts as a catalyst for an accelerated and more successful rehabilitation. Patients who are not limited by discomfort can participate more readily and aggressively in physical therapy sessions, leading to the earlier achievement of critical milestones such as restoring a full range of motion and developing a pain-free gait. Ultimately, this leads to better functional outcomes, a faster return to daily activities, and greater overall patient satisfaction.
Professor Wilson’s Comments
One of my long-standing interests has always been achieving early recovery, minimal pain, and better outcomes for patients. One of the innovations I developed to support this was designed to reduce the discomfort patients experience after harvesting the hamstring tendon during ACL surgery.
The idea was simple yet effective: by passing a thin plastic tube alongside the harvest site up to the top of the hamstring area and injecting long-acting local anaesthetic through it, we could deliver targeted pain relief exactly where it was needed.
This straightforward concept proved remarkably effective and has since been developed into a widely used product that helps patients recover more comfortably after ACL surgery.
For a more detailed exploration of these findings, please refer to the full research:
A New Technique for Hamstring Donor Site Blockade in Anterior Cruciate Ligament Reconstruction
