Positioning Technique of the Fixed Knee in Hyperflexion for the Transportal Femoral Tunnel During Reconstruction of the Anterior Cruciate Ligament

Faria, José Leonardo Rocha de; Pavão, Douglas Melo; Werneck, Fernando Carneiro; Moreirão, Marcos de Castro; Labronici, Pedro José; Mozella, Alan de Paula; Sousa, Eduardo Branco de

doi:10.1016/j.eats.2019.09.011

Cited by 2 publications

(2 citation statements)

References 16 publications

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“…The surgery is performed with the knee suspended beside the surgical table. 4,5 We start the procedure by making a transverse incision of 2 to 3 cm on the anterior aspect of the knee, close to the superior pole of the patella. Using a double-bladed No.…”

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confidence: 99%

Harvesting the Quadriceps Tendon With a Minimally Invasive Approach

Pires,

Monteiro,

Rego

et al. 2023

Video Journal of Sports Medicine

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Background: This article describes a standardized, minimally invasive approach for harvesting the quadriceps tendon through a 2 to 3 cm transverse skin incision, presenting it as a viable option. Indications: This procedure is indicated for patients undergoing anterior cruciate ligament (ACL), posterior cruciate ligament, medial collateral ligament, or lateral collateral ligament reconstruction surgery using soft tissue quadriceps grafts. Technique Description: A transverse incision is made on the anterior face of the knee, followed by a longitudinal incision of the central third of the rectus femoris. We perform the distal detachment of the patella of the same tendon. Then, the tendon is extracted using a closed stripper. The graft is prepared and folded on itself, resulting in a double graft. Results: Twenty patients, 16 male and 4 female with complete rupture of ACL, were submitted to an ACL reconstruction using the quadriceps soft tissue graft with minimally invasive harvesting technique. The results were satisfactory for all patients. All patients showed good evolution in the immediate and late postoperative period, with no cases of joint stiffness, wound dehiscence, and no infections. Discussion/Conclusion: We can conclude that harvesting the quadriceps tendon with a minimally invasive approach is a valid and reliable option for the treatment of ligament tears of the knee. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form.

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Section: Video Transcriptmentioning

confidence: 99%

Harvesting the Quadriceps Tendon With a Minimally Invasive Approach

Pires,

Monteiro,

Rego

et al. 2023

Video Journal of Sports Medicine

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“…During arthroscopy, we identified the ACL stump while preserving its tibial insertion. Subsequently, we created the femoral tunnel using the technique described by Rocha de Faria et al, 2 with the knee fixed in hyperflexion using an L-shaped support. Utilizing a femoral guide, we generated a 5-mm-deep hole in the position indicated by the femoral guide, with the knee maintained at 120°.…”

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Re-tensioning Anterior Cruciate Ligament Reconstruction Using an Adjustable Femoral Button

Rocha de Faria,

Pavão,

de Paula

et al. 2023

Video Journal of Sports Medicine

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Background: Despite advancements in surgical techniques for anterior cruciate ligament (ACL) treatment, persistent functional impairment, reduced quality of life, and limited physical activity participation continue to be common after postoperative rehabilitation. We modify the traditional ACL reconstruction method by using hamstring tendons grafts and re-tensioning them. Indications: This procedure is indicated for patients undergoing ACL reconstruction surgery with soft tissue grafts, utilizing femoral fixation with an adjustable button and tibial fixation with an interference screw. Technique Description: We employ hamstring grafts for ACL reconstruction and perform femoral fixation using an adjustable button. Initially, we pull the graft approximately 10 mm less than the length of the thickest tunnel drill. This allows for subsequent graft traction after tibial fixation. Following tibial fixation, we pull the graft proximally, inserting it a few millimeters further into the femoral tunnel. This re-tensioning increases tension and enhances physical examination results. In addition, we incorporate the braid graft technique to augment the graft's final thickness. Results: This technique yields reduced postoperative residual laxity during physical examinations. Our institution's ethics committee is currently reviewing a clinical study comparing functional outcomes with traditional techniques. Discussion/Conclusion: The ACL re-tensioning technique is easily implemented and involves a subtle modification to the traditional approach, allowing for graft re-tensioning and diminishing the risk of residual laxity post-interference screw fixation. This approach acknowledges that insertion of the interference screw can inadvertently reduce graft tension, counteracting the tension applied during fixation. Consequently, this technique is expected to yield superior clinical outcomes.

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Positioning Technique of the Fixed Knee in Hyperflexion for the Transportal Femoral Tunnel During Reconstruction of the Anterior Cruciate Ligament

Cited by 2 publications

References 16 publications

Harvesting the Quadriceps Tendon With a Minimally Invasive Approach

Harvesting the Quadriceps Tendon With a Minimally Invasive Approach

Re-tensioning Anterior Cruciate Ligament Reconstruction Using an Adjustable Femoral Button

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