All-Inside Anterior Cruciate Ligament Graft-Link Technique: Second-Generation, No-Incision Anterior Cruciate Ligament Reconstruction

Abstract:We describe an anatomic single-bundle anterior cruciate ligament reconstruction using a 4-strand semitendinosus graft fixed with 2 Pullup adjustable suspensory fixation systems (SBM, Lourdes, France). Outside-in full tibial tunnel drilling represents a secure option for length management of the graft. The preferred graft choice is a 4-strand semitendinosus autologous graft. A special technique is used to stitch the graft with a figure-of-8 stitch to load the 4 strands. The Pullup adjustable loop is equipped with 2 buttons of different sizes: a small button for the standard Pullup system on the femoral side and a large button for the Pullup XL system on the tibial side. With this method, graft tension is equally distributed among the 4 strands and the graft cannot bottom out in the tibial tunnel in case of inadequate graft length.

Section: Discussionmentioning

confidence: 99%

“…5,6 It preserves the gracilis and reduces the significant weakness of the hamstring muscle. 7 However, it is a highly demanding technique compared with the classic hamstring tendon graft (gracilis and ST), which is now the most common technique used to reconstruct the ACL all over the world.…”

Section: Discussionmentioning

confidence: 99%

An Anterior Cruciate Ligament Reconstruction Technique With 4-Strand Semitendinosus Grafts, Using Outside-In Tibial Tunnel Drilling and Suspensory Fixation Devices

Colombet

Graveleau

2015

“…As previously described for "all-inside" ACL reconstruction, 3 we use a combined guide pin and retrograde drill (second-generation FlipCutter; Arthrex) to create bone-preserving femoral and tibial sockets. Anatomically contoured instruments from the PCL RetroConstruction Drill Guide Set (Arthrex) are used for socket preparation.…”

Section: Technical Note Instrumentsmentioning

confidence: 99%

“…This typically provides 27 to 29 cm of graft that is then quadrupled in the standard fashion to form a GraftLink construct (Fig 3A), as previously described for all-inside ACL surgery. 3 The graft is typically 8.5 mm in diameter and 70 mm in length. If the GraftLink is of small diameter or there are concerns about graft strength and initial stability, a loop of high-strength composite polymer tape (FiberTape) is incorporated into the construct (Fig 3B).…”

Section: Graft Harvest and Preparationmentioning

confidence: 99%

TransMedial All-Inside Posterior Cruciate Ligament Reconstruction Using a Reinforced Tibial Inlay Graft

Nancoo

Lord

Yasen

et al. 2013

Surgical reconstruction of the posterior cruciate ligament (PCL) is technically demanding. Potential challenges include visualization of the tibial footprint and drilling of the tibial tunnel without damaging posterior neurovascular structures, as well as graft selection, deployment, tensioning, and fixation. We present a novel TransMedial all-inside arthroscopic technique (technique designed by A. J. Wilson with support from Arthrex) using a single hamstring tendon graft, fixed with adjustable cortical suspensory devices. The technique simplifies the difficult steps encountered during PCL reconstruction and is safe and reproducible. All arthroscopic viewing is accomplished from the lateral portal, and femoral socket preparation is performed from the medial side with specially contoured instruments, which allow accurate marking, measuring, and anatomic positioning of the graft. The quadrupled semitendinosus graft can be augmented with composite polymer tape for increased strength and initial stability. We use outside-in drilling to create retrograde femoral and tibial sockets. Cortical suspensory fixation on the tibial side can be supplemented with anchor fixation. We use an arthroscopic tibial inlay technique that better approximates native knee anatomy. This also avoids the "killer turn," a problem seen in transtibial PCL reconstruction techniques, which theoretically induces graft laxity due to abrasion with cyclic loading. This technique can be further adapted to allow a modified double-bundle or TriLink graft (technique designed by A. J. Wilson with support from Arthrex.).

“…Our ACL technique has been previously published with video illustration. 7,8 In this technical note, Video 1 focuses on the posteromedial reconstruction.…”

mentioning

confidence: 99%

Knee Medial Collateral Ligament and Posteromedial Corner Anatomic Repair With Internal Bracing

Lubowitz¹,

Mackay²,

Gilmer³

2014

Self Cite

115

An internal brace is a ligament repair bridging concept using braided ultrahighemolecular-weight polyethylene/polyester suture tape and knotless bone anchors to reinforce ligament strength as a secondary stabilizer after repair and return to sports, which may help resist injury recurrence. An internal brace may provide augmentation during knee medial and posteromedial corner anatomic repair. In patients with combined, chronic, symptomatic anterior cruciate ligament (ACL)eposteromedial corner laxity, combined ACL reconstruction with posteromedial corner reconstruction is indicated. Our ACL technique was previously published with video illustration in Arthroscopy and Arthroscopy Techniques. The purpose of this article is to describe, with video illustration, knee posteromedial corner reconstruction using anatomic repair with internal brace augmentation.