TransLateral ACL reconstruction: a technique for anatomic anterior cruciate ligament reconstruction

Abstract

Anatomic placement of the femoral tunnel in anterior cruciate ligament (ACL) reconstruction confers biomechanical advantages over the traditional tunnel position. The anteromedial portal technique for anatomic ACL reconstruction has many well-described technical challenges. This paper describes the TransLateral technique. The technique produces anatomic femoral tunnel placement using direct measurement of the medial wall of the lateral femoral condyle and out to in drilling. All work is carried out through the lateral portal with all viewing via the medial portal. There is no need for an accessory medial portal or hyperflexion of the knee. Level of evidence Expert opinion, Level V.

Combined All-Inside Anterior Cruciate Ligament Reconstruction and Minimally Invasive Posterolateral Corner Reconstruction Using Ipsilateral Semitendinosus and Gracilis Autograft

“…All-inside ACL reconstruction facilitates anatomic placement of the graft. 15,16 This more accurately replicates the biomechanics of the native ACL and more accurately restores knee kinematics in comparison to nonanatomic reconstruction. 15,17 Specifically, traditional transtibial graft placement tends to place the femoral tunnel high and deep within the intercondylar notch with respect to the ACL footprint, creating a vertically oriented graft that fails to restore rotational stability.…”

TriLink: Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction

“…Drilling can be undertaken through an accessory AM portal or with our TransLateral technique. 30 ACL footprint anatomy has been defined, 42 and identification of the mid-bundle position on the femur can be achieved with the direct measurement technique, which has been validated. 32 Biomechanical testing has shown that single-bundle anatomic positioning confers advantages over traditional graft placement, but further improvements may be obtained by double-bundle reconstruction.…”

“…The triple suspensory fixation system of the TriLink construct makes this possible, in contrast to previously published doublebundle/single-tibial techniques. 25 We tension the PL bundle in extension and the AM bundle in 30 to 40 of flexion to better replicate normal functional anatomy.…”

“…The surgical approach is based on the TransLateral ACL reconstruction technique previously published by our group 30 (Video 1). A summary of the pertinent steps is presented in Table 1.…”

“…On the femoral side, the AM bundle is first tensioned in extension using the TightRope RT, followed by the PL bundle with the standard TightRope. The AM bundle is then re-tensioned at 30 to 40 of flexion. This is based on the typical physiological angles when these bundles become taut in the normal knee.…”