A new technique for hamstring donor site blockade in anterior cruciate ligament reconstruction

Js, Logan; Elliot, RR; Wilson, AJ

doi:10.1308/rcsann.2011.93.4.326b

Cited by 5 publications

(5 citation statements)

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“…The fixation is assessed for tension and strength by cycling the knee several times before finally cutting the suture ends. The incisions and hamstring harvest tract are infiltrated with local anaesthetic [23], before closure with absorbable subcuticular sutures and application of impermeable skin dressings. Radiographs are taken post-operatively to verify fixation position (Fig.…”

Section: Technical Notementioning

confidence: 99%

Combined anterolateral ligament and anatomic anterior cruciate ligament reconstruction of the knee

Smith

Yasen

Lord

et al. 2015

Knee Surg Sports Traumatol Arthrosc

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Although anatomic anterior cruciate ligament (ACL) reconstruction is established for the surgical treatment of anterolateral knee instability, there remains a significant cohort of patients who continue to experience post-operative instability. Recent advances in our understanding of the anatomical, biomechanical and radiological characteristics of the native anterolateral ligament (ALL) of the knee have led to a resurgent interest in reconstruction of this structure as part of the management of knee instability. This technical note describes our readily reproducible combined minimally-invasive technique to reconstruct both the ACL and ALL anatomically using autologous semitendinosus and gracilis grafts. This simple method of ALL reconstruction can be easily integrated with all-inside ACL reconstruction, requiring minimal additional operative time, equipment and expertise. Level of evidence: VThe final publication is available at Springer via http://dx.doi. org/10.1007/s00167-015-3783-5 Copyright © 2015, Springer Verlag. Introduction 1Although the existence of the anterolateral ligament (ALL) was first described in anatomical studies 2 over a century ago, a full appreciation of its functional importance in normal and sporting activities is 3 still being established [3,14,19,20,29,32,35,36]. Recent progress has been made in reconstructing 4 the unstable knee, but this has mainly concentrated on restoring the mechanical constraints of the 5 cruciate and collateral ligaments, with little consideration for the potential of the ALL itself as a key 6 supportive structure [5,26]. Cruciate ligament reconstruction alone can provide excellent clinical 7 outcomes, however, a significant proportion of patients continue to suffer from rotational instability 8 post-operatively, with many patients unable to return to their pre-injury level of sporting activity [2]. 9Furthermore, even when the cruciate ligaments are reconstructed anatomically, the procedure does 10 not prevent the progression to early secondary osteoarthritis [21]. Although its function remains 11 controversial, a new appreciation for the existence of the ALL as a distinct anatomical structure with 12 the potential to confer rotational stability to the knee, has led several groups to advocate 13 refinements to previous extra-articular ligament reconstruction techniques to more precisely restore 14 the kinematics of the native knee [8,15]. It is proposed that these procedures, when used in 15 conjunction with arthroscopic anatomic anterior cruciate ligament (ACL) reconstruction, will be 16 particularly beneficial to those patients who present with both anterolateral and rotatory knee 17 instability, or who remain unstable despite standard ligament reconstruction. 18Following collaboration with other research groups and preliminary cadaveric studies, the senior 19 author developed a minimally invasive anatomic technique with which to reconstruct the 20 anterolateral corner of the knee using gracilis tendon autograft, in conjunction with 'All-inside' 21 ...

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Section: Technical Notementioning

confidence: 99%

Combined anterolateral ligament and anatomic anterior cruciate ligament reconstruction of the knee

Smith

Yasen

Lord

et al. 2015

Knee Surg Sports Traumatol Arthrosc

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“…2,3 In these descriptions, the injection was given via a blunt device such as a suction catheter or arthroscopic shaver sleeve into the donor site space, without image guidance. The use of ultrasonography guidance allows anaesthetic to be introduced to the target site with improved accuracy.…”

Section: Discussionmentioning

confidence: 99%

“…It has been suggested that trochanteric sparing osteotomies may be desirable. 3 We describe a technique that reliably provides access to an implanted stem, aiding removal while avoiding osteotomy of the greater trochanter, maintaining bone stock and an intact circular rim.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography guided peritendinous anaesthetic infiltration in hamstrings autograft anterior cruciate ligament reconstruction

Walter

Dhadwal

Htyn

et al. 2014

annals

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“…34 The wounds are closed with absorbable sutures and standard dressings applied. The postoperative regimen is unchanged from standard ACL surgery.…”

Section: Postoperative Rehabilitationmentioning

confidence: 99%

TriLink: Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction

Yasen

Logan

Smith

et al. 2014

Arthroscopy Techniques

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Cadaveric and clinical biomechanical studies show improved kinematic restoration using double-bundle anterior cruciate ligament (ACL) reconstruction techniques. These have been criticized in the past for being technically challenging. We present a novel 3-socket approach for anatomic "all-inside" double-bundle reconstruction using a single hamstring tendon fashioned to create a trifurcate graft: the TriLink technique. The semitendinosus alone is harvested, quadrupled, and attached to 3 suspensory fixation devices in a Y-shaped configuration, creating a 4-stranded tibial limb and 2 double-stranded femoral limbs. A medial viewing/lateral working arthroscopic approach is adopted using specifically designed instrumentation. Anatomic placement of the 2 femoral tunnels is performed by a validated direct measurement technique. A single mid-bundle position is used on the tibia. Both femoral and tibial sockets are created in a retrograde manner using outside-to-in drilling. This is a simplified operative technique for anatomic double-bundle ACL reconstruction that maximizes bone preservation. The TriLink construct replicates the 2 bundles of the ACL, conferring native functional anisometry and improving femoral footprint coverage while avoiding the complexities and pitfalls of doubleetibial tunnel techniques. Preservation of the gracilis reduces the morbidity of hamstring harvest and allows greater flexibility in graft choice in cases requiring multiligament reconstruction.

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A new technique for hamstring donor site blockade in anterior cruciate ligament reconstruction

Cited by 5 publications

References 1 publication

Combined anterolateral ligament and anatomic anterior cruciate ligament reconstruction of the knee

Combined anterolateral ligament and anatomic anterior cruciate ligament reconstruction of the knee

Ultrasonography guided peritendinous anaesthetic infiltration in hamstrings autograft anterior cruciate ligament reconstruction

TriLink: Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction

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