engleski

New modified anterior cruciate ligament and anterolateral ligament reconstruction technique

Purpose: The anterior cruciate ligament (ACL) is one of the most signifi cant structures that maintain knee-joint stability by limiting rotation and restricting anterior tibial translation on the femur. It is the most frequently injured knee ligament in athletes participating in contact and pivot sports. If athletes want to continue at the same level they are advised to undergo ACL reconstruction. Despite all technical improvements, some patients continue to have rotational instability postoperatively. The aim of our new technique is to achieve anatomical ACL reconstruction, rotational stability, strong graft fi xation and to decrease bone removal. Surgical technique: The patient is supine with an injured leg in a leg holder and knee fl exed at 90°. Head of the fibula, the Gerdy tubercule, lateral epicondyle of femur, points for drilling ALL tunnels and the position of arthroscopic portals are marked. Two convergent tunnels on the tibia are created and connected, a guide wire is positioned proximal and posterior to lateral epicondyle. Suture is tied from tibial tunnels to guide wire to check the isometry of the ALL graft. Two hamstrings tendons are harvested to make a four strand graft (tripled ST and one strand GR). The ACL TightRope is combined with four strand graft. The femoral ACL tunnel is made with „outside in“ technique and is positioned intraarticularly at the footprint of the native ACL on lateral femoral condyle. The tibial tunnel is positioned at the tibial ACL remnant. The tibial ACL tunnel drilling is performed with a RetroDrill to decrease bone removal. The ACL remnant is always preserved. When the ACL graft placement is confi rmed interference screw is put into femoral tunnel. During screw positioning knee is at the 30° of knee fl exion. G tendon is passed through ALL tunnels and tied with sutures from the femoral tunnel with knee in full extension. At the end, if necessary, the ACL graft is tensioned with TightRope. Discussion: Earlier combined ACL reconstruction and nonanatomic extra-articular lateral tenodesis had good rotational control, but limited range of motion and poor clinical results. Latest described surgical technique diff erentiated from previously published extra-articular lateral tenodesis and has better clinical results for now (Sonnery-Cottet et al., 2015). Conclusion: Possible benefi ts from our new modifi ed technique is decreased bone removal at the tibial side and more precise tensioning of the graft.

ligament ; reconstruction

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