Abstract:Anatomical anterior cruciate ligament (ACL) reconstruction is a reasonable transition from isometric ACL reconstruction to obtain better clinical outcomes, and most authors believe that it can only be performed through the medial portal technique. However, in our clinical practice, we found that anatomical ACL reconstruction can be performed easily and accurately by creating a tibial tunnel, which is accomplished by setting the tibial tunnel with correct angulation to the sagittal plane and tibial axis. Hence,… Show more
“…Because the diameter of the AM bundle tibial tunnel is at least 8 mm and its length is as short as 30 to 35 mm, the extent of change in the direction of the femoral tunnel aiming device within the tibial tunnel is quite great. 5 During creation of the tibial tunnels, drilling of the K-wire to the femoral side to evaluate the projection of the tibial tunnel is essential. Adjustment of its angulation to the sagittal plane and the tibial axis is always needed.…”
Section: Discussionmentioning
confidence: 99%
“…The traction sutures are pulled from the underside of the quadriceps out of the lateral incision. Proximal suspension fixation is completed by tying the sutures on mini-plates (Smith & Nephew) over the lateral orifices 5 ( Fig 10 ). Fig 10 Proximal fixation of grafts on mini-plates (A) and inner orifices of femoral tunnels (B) on 3-dimensional computed tomography (right knee).…”
Section: Surgical Techniquementioning
confidence: 99%
“…The suture limbs passing through the adjustable loop are tied to their counterparts to fix the graft at the adjustable loop ( Fig 11 ). 5 Finally, the adjustable loop is reduced to tension the graft. Fig 11 Distal fixation of grafts at adjustable loop (right knee).…”
Double-bundle anterior cruciate ligament (ACL) reconstruction (DBACLR) is a reasonable transition from single-bundle ACL reconstruction to obtain better clinical outcomes, and most authors believe that it can only be performed through a medial portal. However, in our clinical practice, we have found that anatomic DBACLR can be performed easily and exactly through transtibial tunnels just by positioning the tibial tunnels appropriately. Thus, we would like to introduce this anatomic double-bundle transtibial ACL reconstruction technique, in which the most critical step is to create a shallow tibial tunnel for the anteromedial bundle with a proximal projection to the anatomic location of the corresponding femoral tunnel. We believe this Technical Note will give an interesting view of anatomic DBACLR.
“…Because the diameter of the AM bundle tibial tunnel is at least 8 mm and its length is as short as 30 to 35 mm, the extent of change in the direction of the femoral tunnel aiming device within the tibial tunnel is quite great. 5 During creation of the tibial tunnels, drilling of the K-wire to the femoral side to evaluate the projection of the tibial tunnel is essential. Adjustment of its angulation to the sagittal plane and the tibial axis is always needed.…”
Section: Discussionmentioning
confidence: 99%
“…The traction sutures are pulled from the underside of the quadriceps out of the lateral incision. Proximal suspension fixation is completed by tying the sutures on mini-plates (Smith & Nephew) over the lateral orifices 5 ( Fig 10 ). Fig 10 Proximal fixation of grafts on mini-plates (A) and inner orifices of femoral tunnels (B) on 3-dimensional computed tomography (right knee).…”
Section: Surgical Techniquementioning
confidence: 99%
“…The suture limbs passing through the adjustable loop are tied to their counterparts to fix the graft at the adjustable loop ( Fig 11 ). 5 Finally, the adjustable loop is reduced to tension the graft. Fig 11 Distal fixation of grafts at adjustable loop (right knee).…”
Double-bundle anterior cruciate ligament (ACL) reconstruction (DBACLR) is a reasonable transition from single-bundle ACL reconstruction to obtain better clinical outcomes, and most authors believe that it can only be performed through a medial portal. However, in our clinical practice, we have found that anatomic DBACLR can be performed easily and exactly through transtibial tunnels just by positioning the tibial tunnels appropriately. Thus, we would like to introduce this anatomic double-bundle transtibial ACL reconstruction technique, in which the most critical step is to create a shallow tibial tunnel for the anteromedial bundle with a proximal projection to the anatomic location of the corresponding femoral tunnel. We believe this Technical Note will give an interesting view of anatomic DBACLR.
“…In the tibial tunnel plane, the tibial tunnel angulates the tibial axis at approximately 50 . 6 A K-wire is drilled through the tibia to the femur to ensure that it can reach a point within 5 mm from the femoral tunnel center. Microadjustment may be needed through multiple tries.…”
In anterior cruciate ligament (ACL) reconstruction, fixation of the graft with hardware is a routine procedure. However, in some cases when the hardware is not intended to be used or is unavailable, ACL reconstruction with hardware-free fixation must be the treatment of choice. We introduce a single-bundle anatomical hardware-free ACL reconstruction technique in which a set of Y-shaped femoral tunnels is created for the fixation of the proximal end of the graft over the bone bridge between the 2 outer orifices, and a transtibial ridge tunnel is created to set a suture loop with a knot for the fixation of the distal end of the graft at the suture loop. We believe the introduction of this technique will provide a reasonable option for single-bundle anatomical ACL reconstruction.
“…Single-bundle and double-bundle anatomic anterior cruciate ligament reconstruction (ACLR) are common techniques for ACL injuries. In recent the decade, single-bundle anatomic ACLR has been widely recognized because of its similar clinical effect and easier surgical techniques than double-bundle anatomic ACLR [1][2][3][4]. However, it is still controversial whether double-bundle or single-bundle reconstruction will provide superior clinical results.…”
Purpose We modified the hamstring tendon graft into the hamstring-bone composite graft in double-bundle anterior cruciate ligament reconstruction for anterior cruciate ligament (ACL) injuries. Here, we evaluated the technique's effectiveness by investigating the clinical results in restoring the stability and function of the knee joint. Methods We reviewed 42 patients who underwent anterior cruciate ligament reconstruction (ACLR) with the hamstring-bone graft for ACL injuries from January 2013 to April 2015, with an average follow-up of 66.6 months. The objective evaluations (KT-1000, Lachman test and pivot-shift test) and the subjective evaluations (International Knee Documentation Committee (IKDC) scores, Lysholm scores, and Tegner scores) were performed preoperatively and postoperatively. Results Forty-one of 42 patients were negative in the Lachman test and forty of 42 patients were negative in the pivot-shift test after the operation at the final follow-up time. The IKDC, Lysholm, and Tegner scores improved significantly from 56.24±9.28 to 85.33±3.37, from 62.00±11.09 to 90.43±3.71，and from 2.3±0.87 to 6.5±0.67 at the final follow-up. Conclusion Double-bundle anatomic ACLR with a hamstring-bone composite graft can restore the anteroposterior and rotational stability for ACL injuries. The modified technique can provide excellent clinical outcomes with a long-term follow-up.
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