Single Femoral Tunnel for Anterior Cruciate Ligament Reconstruction With Bone-Patellar Tendon-Bone Graft and Lemaire's Extra-Articular Tenodesis as a Good Alternative for Combined Anterior Cruciate Ligament and Anterolateral Ligament Revision Surgeries

Goes, Rodrigo Araújo; Silva, Rafael Pereira da; Oliveira, Filomena; Castelhanito, Pedro; Cruz, Raphael Serra; Faria, José Leonardo Rocha de

doi:10.1016/j.eats.2023.02.026

Cited by 2 publications

(1 citation statement)

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“…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. [3][4][5] We modify the traditional ACL reconstruction method by using hamstring tendon grafts and re-tensioning them using an adjustable button.…”

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confidence: 99%

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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Section: Video Transcriptmentioning

confidence: 99%

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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View full text Add to dashboard Cite

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Localizing the position of the Segond fracture bed under CT measurements to determine the functional tibial insertion of an anterolateral ligament

et al. 2023

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BackgroundMany studies have confirmed the existence of ligament structures in the anterolateral region of the knee that maintain rotational stability of the knee joint, namely, the anterolateral ligament (ALL). Most scholars believe that knee joint reconstruction should be considered during revision surgery and a high level of pivot displacement test (stage 2 or 3). During ALL reconstruction, the choice of ligament reconstruction sites affects the success rate and prognosis of the operation. Therefore, the choice of ligament reconstruction sites is particularly important. There is little research on the lateral ALL tibia insertion point, and most clinicians use the midpoint Gerdy's tubercle and fibular head as insertion points. However, the reconstruction effect is not ideal.ObjectiveThis study aims to measure the position of the Segond fracture bed on CT images to determine the ALL position of the tibia.MethodTo determine the position of the Segond fracture bone bed, the CT AM Volume Share 2 system was used to manually measure the position of bone fragments in 23 Segond fracture patients. Using the highest point of Gerdy's tubercle in the CT axial slices and the outermost point of the fibular head in the CT axial slices as reference points, the direction and angle of the CT slices were adjusted to ensure that the highest point of the Gerdy tubercle, the outermost point of the fibular head, and the center of Segond fracture bed were in the same sagittal slice. A CT sagittal slice measures the vertical distance from the center of the Segond fracture bed to the Gerdy-fibular line segment (G-F line segment), which is the line connecting the highest point of the segment to the outermost point of the fibula. The distance from the vertical point at the center of the Segond fracture bed of the G-F line to the highest point of the Gerdy tubercle was measured. All measurements were performed using the same measurement standard and were expressed as a percentage of the length of the G-F line. The measured results were statistically analyzed using SPSS 25.0 descriptive statistical research methods.ResultsThe average length of the G-F segment measured on CT images was 39.6 ± 2.0 mm, and the average vertical length from the center of the Segond fracture bed to the G-F segment was 13.1 ± 1.1 mm, accounting for 33.2% ± 2.1% of the length of the G-F segment. The length from the vertical point of the fracture bed on the G-F line segment to the highest point of the Gerdy tubercle was 14.7 ± 1.3 mm, accounting for 37.1% ± 2.9% of the length of the G-F segment.ConclusionThrough the study of the CT measurement of the Segond fracture location, we obtained the location of the functional tibial insertion of ALL, which is different from the anatomical insertion of ALL and is more inclined to the Gerdy tubercle and above, which has reference value for the treatment of recovering the function of anterolateral ligament after reconstruction.

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Single Femoral Tunnel for Anterior Cruciate Ligament Reconstruction With Bone-Patellar Tendon-Bone Graft and Lemaire's Extra-Articular Tenodesis as a Good Alternative for Combined Anterior Cruciate Ligament and Anterolateral Ligament Revision Surgeries

Cited by 2 publications

References 30 publications

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

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

Localizing the position of the Segond fracture bed under CT measurements to determine the functional tibial insertion of an anterolateral ligament

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