Achilles Tendon Allograft Preparation Technique for Anterior Cruciate Ligament Reconstruction: A Technical Note

Abstract

Several factors associated with graft preparation for the surgery of the anterior cruciate ligament (ACL) like the wrong thawed, prophylaxis, bone cuts, excessive bone removal as well as positioning problems like a tunnels-graft mismatch, insufficient harvesting of the donor's tendon, size graft limitations (length and diameter), uncontrolled rotation of graft in their longitudinal axis, over or under tensioned graft, fixation mistakes, bone defects, secondary arthrofibrosis or morbidity of the donor site, and others factors importantly affect the outcomes of the ACL surgery. In this sense, the Achilles tendon Allograft is an advantageous technique where many of the previous limitation factors described can be controlled during an appropriate preparation. However, to obtain the maximum potentialities of the graft a detailed knowledge of the preparation is required. Hence, we aimed to describe how to prepare the Achilles tendon Allograft to control the graft's length and diameter, bone removal, and fixation requirements.

Finite element graft stress for anteromedial portal, transtibial, and hybrid transtibial femoral drillings under anterior translation and medial rotation: an exploratory study

“…We identify that the main limitation would be the native geometry of our ACLr graft. However, we have used a similar graft among the techniques based on the recommendations for using the Achilles allograft 21 . Our model validation did not have the same boundary conditions for coronal and transverse knee planes, and it has been considered exclusively the sagittal plane where the main knee motion occurs.…”

“…Finally, an ACLr graft with a 9 mm diameter was attached with a width of 25 mm (Fig. 1) based on Achilles graft preparation 21 . The node and total elements were 8812/42,454, 11,482/53,070, and 9776/48,076 units for the AM portal, TT, and HTT, respectively.…”

Exploratory Anterior Cruciate Ligament Graft Stress during Medial Knee Rotation with and without Iliotibial Band–Intermuscular Septum Lateral Extra-Articular Tenodesis for Transtibial and Anteromedial Femoral Tunnels

“…The sagittal orientation angles for the AM portal, TT, and HTT were 146.3 • , 155.4 • , and 158.8 • , respectively, while the coronal orientation angles were 100.5 • , 129.4 • , and 111.0 • for the AM portal, TT, and HTT, respectively [28]. Subsequently, an ACLr graft with a diameter of 9 mm and a width of 25 mm was affixed based on Achilles graft preparation [29]. In this research, the TT, AM portal, and HTT drillings were performed using the same ACLr graft.…”

Achilles Allograft Fiber Track Graft Preparation Technique for Anterior Cruciate Ligament Reconstruction

“… 9 , 10 , 11 The Achilles tendon provides several advantages, such as sufficient graft length, sufficient graft width, a bone block, and the ability to use the excess allograft tendon for additional ligament reconstruction. 12 , 13 , 14 Additionally, it can be used to combat rotatory instability, which is a common cause of primary reconstruction failure. 15 …”