Anatomic Outside-In Anterior Cruciate Ligament Reconstruction Using a Suspension Device for Femoral Fixation

Abstract

Cortical suspension is one of the most frequently used methods of femoral fixation in anterior cruciate ligament reconstruction. We present a simple technique for anterior cruciate ligament reconstruction using a suspension device for femoral fixation. The purposes of this technique are to ensure greater contact between the graft and the tunnel wallsda goal that is achieved by using the femoral fixation device with the shortest possible loopdto avoid the flip step and the need for hyperflexion, and in short, to minimize the risk of complications that can occur when using the anteromedial portal to drill the femoral tunnel. To this end, both the femoral and tibial tunnels are created in an outside-in manner and with the same guide. The graft is passed through in a craniocaudal direction, and the suspension device is fitted inside an expansion piece for a better adaptation to the femoral cortex.

Associated Anterior Cruciate Ligament and Fibular Collateral Ligament Reconstruction With Single Femoral Tunnel and Asymmetric Hamstring Tendon Graft

“…The outside-in technique offers the invaluable advantage of choosing both the entry and end point of the tunnel, and so this tunnel goes from the anatomic femoral insertion of the FCL 14 , 15 , 16 to the anatomic femoral insertion of the ACL. 17 , 18 , 19 Therefore, this tunnel requires only 1 graft to satisfy the anatomic requirements of both the ACL and FCL. In addition to this essential feature, the outside-in tunnel offers other advantages: it can be created with the knee in the same position during the entire procedure, avoiding the need for the hyperflexion required when the inside-out technique is used through the anteromedial portal.…”

Associated Reconstruction of Anterior Cruciate and Anterolateral Ligaments With Single Asymmetric Hamstring Tendons Graft

“…In the technique here shown hamstring tendons are used in the same manner as in isolated ACL reconstruction, 19 only changing the length of both ends, which are prepared asymmetrically (leaving approximately one-third of the length for the short end and two-thirds for the long one); in a, for example, 27-cm-long graft, a 9-cm-long and double-diameter graft would be prepared for ACL reconstruction and a 9-cm-long and single-diameter graft would remain for ALL reconstruction. In cases with short length tendons, the loop length of the suspension device would be increased.…”

Posterior Cruciate Ligament Reconstruction With Hamstring Tendons Using a Suspensory Device for Tibial Fixation and Interference Screw for Femoral Fixation

“…3,6 Femoral cortical suspension fixation has largely been described for ACL reconstruction [7][8][9] ; however, it has barely been described for PCL reconstruction, and in most of these cases, it has been described for all-inside techniques, 10,11 including non-hardware techniques. 12 As is known, the tibial tunnel length is longer for transtibial PCL reconstruction than for ACL reconstruction, 3 so a longer graft is needed.…”