ACL-Reconstruction using Patellar Tendon

Introduction and References

Short description of the method

The deficient anterior cruciate ligament is arthroscopically replaced without tourniquet by the middle third of the patient's own patellar tendon. The graft is harvested through two small transverse incisions with two semi-cylindrical bone plugs on either end (Mishra). The femoral socket is created endoscopically via the antero-medial arthroscopy portal and not transtibially "single-shot". The femoral socket and the tibial tunnel are not drilled but created by the compaction-dilation technique which leads to a firmer fixation and acts biologically like a circumferential bone graft. (Johnson).

The introduction of the graft is performed through the tibial tunnel using a threaded K-wire inserted into the femoral bone plug. The graft is fixed by two bioabsorbable interference screws. These screws have a special design which offers optimal transmission of forces from the screwdriver to the screw.

Advantages of this method

By not using a tourniquet the neurovascular structures are neither compromised by direct pressure nor ischemia. This allows an uncomplicated postoperative recovery. (Guanche, Gutin). The two small transverse incisions are cosmetically pleasing and cause less postoperative pain and fewer complications, because they do not injure the patellar retinaculum (Mishra). The patellar tendon graft is harvested with semi-cylindrical bone plugs on either end. This reduces the risk of patellar fractures and leads to a tight press fit of the bone plugs within the bony tunnels (Shapiro).

The femoral socket is approached via the antero-medial arthroscopy portal. This allows optimal placement at the posterior notch without being compromised by a narrow transtibial tunnel (O'Donnell). The femoral socket and tibial tunnel are created by the compaction dilation technique and not drilled. Thus the soft cancellous bone is compacted in order to get a firmer seat for the interference screws (Johnson). The graft is pushed with a threaded K-wire through the tibial tunnel which facilitates the correct rotation of the proximal bone plug within the femoral socket and makes a lateral incision obsolete.

The fixation of the graft is performed by using bioabsorbable SYSORB-interference screws. These screws offer a safe primary fixation, allow undisturbed radiographic evaluation of the entire knee joint and no second operations for hardware removal will be necessary (Barber, Johnson, Stahelin.)

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