Implantless Supplementary Fixation of Anterior Cruciate Ligament in Tibia with “Make and Use” Anchor
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PROVIDER: S-EPMC10907883 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:Good to excellent results at long-term follow-up have been published for anterior cruciate ligament reconstruction with bone-tendon-bone graft. Despite improvements in fixation devices, concerns regarding the stability of graft fixation on the tibial side remain. We present supplementary tibial fixation for anterior cruciate ligament reconstruction with bone-tendon-bone graft using a transosseous technique that is simple and inexpensive and avoids the risk of symptomatic hardware.
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Project description:This technical note outlines a minimalist arthroscopic approach to anterior cruciate ligament avulsion fracture fixation using a bioabsorbable knotless suture anchor. This method represents a less invasive alternative to traditional techniques, catering specifically to fractures classified as Meyers and McKeever type II or III. The procedure is performed through standard anterolateral and anteromedial portals without the need for additional incisions or bone tunnel drilling, making it particularly suitable for children and adolescent patients with open physes. The technique involves the use of a suture hook to pass a double-stranded suture through the anterior cruciate ligament, anchored eccentrically to the anterior tibial incline with a knotless suture anchor. This approach allows for anatomic reduction with adjustable tension and without the potential risk of iatrogenic osteochondral injury. Nonetheless, it should be acknowledged that prospective biomechanical studies and larger patient samples are necessary to validate this technique compared with existing fixation methods.
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Project description:Fixation of the graft during anterior cruciate ligament reconstruction surgery has been the subject of numerous technical innovations but still remains a challenge. This article describes a novel technique of graft fixation for hamstring tendon reconstruction: the Cage For One system (Sacimex, Aix-en-Provence, France). The technique uses only the semitendinosus tendon, which is looped to create a 4-strand graft. Leaving the gracilis tendon intact probably reduces the loss of knee flexion strength. The graft is indirectly anchored into both tunnels with polyetheretherketone cages by use of polyethylene terephthalate tape strips. Both cages and strips are magnetic resonance imaging compatible and do not create artifacts. The tunnels are drilled by an outside-in method with minimal incisions. This type of fixation creates a 360° bone contact at 1.5 cm in each tunnel and is compatible with double-bundle reconstruction. This easy-to-use novel technique of fixation for anterior cruciate ligament reconstruction produces a strong 4-strand graft while harvesting only the semitendinosus tendon and leaving the gracilis tendon intact to reduce flexion strength loss and preserve rotatory stability of the knee. It creates an immediate solid fixation that is independent of graft integration in the early postoperative period, allowing the patient to start immediate rehabilitation without the use of a brace.
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Project description:An anterior cruciate ligament (ACL) tear is one of the most common ligament injuries in athletes. The arthroscopic ACL reconstruction procedure is the gold standard for treatment. However, the improvement in injury classification and suture materials has subsequently made arthroscopic ACL primary repair an alternative surgical treatment option. This Technical Note describes an arthroscopic ACL primary repair with synthetic augmentation made of several high-strength sutures and fixation with the knotless suture anchor. The reinforced synthetic material acts as a structural tie to support the ACL while it heals.
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Project description:Anterior cruciate ligament avulsion fractures are more commonly seen in children with open physes than in adults. Arthroscopic fixation is considered the gold standard in the management of such injuries. Our technique of anterior-row fixation for these injuries provides various advantages in the form of physeal-sparing, complete anatomic reduction with no anterior beaking, no arthrofibrosis, no residual instability, no intra-articular hardware, no need for a second operation to remove implants, and finally, a full range of movement with no loss of extension. Compared with other methods of fixation, our technique uses no tunnels; requires only 3 portals; yields no iatrogenic cartilage or meniscal injury; uses a single implant (anterior-row anchor); and is bone sparing, economical, and simple.
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Project description:Avulsion fractures of the tibial spine (also called "tibial eminence fractures" or "ACL avulsion fractures"), leading to discontinuity of anterior cruciate ligament (ACL) fibers, have been well described in the literature in both the pediatric and adult populations. To ensure the stability of the knee joint and good range of motion with minimal to no laxity, surgical reduction of the fracture and fixation are necessary to restore ACL length. Several arthroscopic techniques have been described to reduce and fix these fractures. We describe a technique using 2 anchors to fix the fractured tibial spine with no need to make any tibial tunnels or any extra leg wounds for the sutures.
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Project description:Implant-free press-fit tibial fixation technique has gained popularity recently due to the problems in bone tunnel expansion, defect, and revision surgery due to the tibial fixation material preferred in anterior cruciate ligament surgery. Patellar tendon-tibial bone autograft offers several advantages in anterior cruciate ligament reconstruction. We describe a tibial tunnel preparation method and the use of patellar tendon-bone graft in the implant-free tibial press-fit technique. We call this the Kocabey press-fit technique. Technique Video Video 1 İllustration of the tibial press-fit fixation technique in anterior cruciate ligament reconstruction.
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