Anatomic anterior cruciate ligament reconstruction: the two-incision technique

Abstract

This article describes the anatomical two-incision reconstruction of anterior cruciate ligament (ACL) of knee. The major part of currently single incision tibial endoscopic techniques attempts to reproduce the most isometric anteromedial bundle of ACL. Often a relatively vertical femoral tunnel, respect to the notch, is drilled, which is not really efficacious in providing rotatory stability. The single incision technique was developed to obviate the necessity of the lateral femoral incision and dissection. This technical note describes a two-incision ACL reconstruction using an instrumentation, which avoids a large lateral femoral soft tissue dissection, and discusses the rational use of the two-incision ACL reconstruction technique.

Reconstruction Technique Affects Femoral Tunnel Placement in ACL Reconstruction

“…Instead, the ACL appeared to be a continuous structure consisting of many different fiber bundles of different lengths and orientations. Although we did not separate the ACL stump into two or three bundles, the data generated from this study are important, as anatomic femoral tunnel placement has been a concern in single-and double-bundle ACL reconstructions [16,55], and whether a single-or double-bundle reconstruction should be performed remains controversial [1,10,26,41,43,47,49,52] and is outside the scope of this study. Finally, we do not know how much difference in placement will substantially alter the risk of either graft failure or long-term degeneration; both would require clinical confirmation.…”

“…Although we aimed for placement of the guide pin in the middle of the attachment site [7,16,54], optimal graft placement for restoring normal motion under physiologic loading conditions is unknown. Cadaver studies suggest that placing the graft closer to the center of the attachment site might improve knee kinematics compared with an anterior graft placement.…”

“…Several biomechanical studies show tunnels placed at the 11 o'clock position restore anterior tibial stability under anterior tibial loads but fail to control rotational stability [35,44]. In addition, a graft placed too far anteriorly could result in a vertically oriented graft [5,9,16,25,29,56]. A vertically oriented graft is unlikely to restore the oblique orientation of the ACL [9,32,44,54] and might provide inadequate restraint to the increased internal rotation [4,12,17] and medial tibial translation [12,31] observed in patients with ACL deficiency.…”

“…Frequently, the grafts are placed too far anteriorly on the femur, resulting in a vertically oriented graft [5,9,16,25,29,56]. Several in vitro studies suggest a graft placed too far anteriorly on the femur results in excessive tension in the graft in flexion, which could lead to graft failure [8,56].…”

Resistência mecânica do ligamento patelar após a retirada do terço médio com incisão longitudinal ou duas mini-incisões transversas

“…Kartus et al (1) , Carneiro et al (2) , Tsuda et al (3) e Garofalo et al (11) , demonstraram como as técnicas menos invasivas de retirada de enxerto usando duas mini-incisões podem resultar em benefício aos pacientes mostrando resultados animadores.…”