Dataset Information

Combined Anatomic Reconstruction of the Anterior Cruciate and Anterolateral Ligaments Using Hamstring Graft Through a Single Femoral Tunnel and With a Single Femoral Fixation.

ABSTRACT: Patients with complete anterior cruciate ligament (ACL) injury have different degrees of rotational (internal rotation) laxity. A residual pivot shift has been found to be positive in more than 15% of cases after an accurate ACL reconstruction. Improved understanding of the existence, function, and biomechanical role of the anterolateral ligament (ALL) in controlling rotational instability of the knee has redirected and refocused attention on a supplemental extra-articular reconstruction of the ALL in conjunction with the intra-articular ACL reconstruction so as to restore normal kinematics of the knee. This Technical Note describes a technique that allows for a combined ACL and ALL reconstruction using autogenous hamstring graft (semitendinosus and gracilis tendons). One femoral tunnel is used connecting the anatomic femoral attachment of the ALL on the lateral wall of the lateral femoral condyle to the anatomic femoral ACL footprint on the medial wall of the lateral femoral condyle. The remaining part of the graft is fixed to the proximal tibia midway between Gordy's tubercle and the head of the fibula. This Technical Note describes a technique of both ACL and ALL reconstruction with a continuous hamstring graft.

SUBMITTER: Zein AMN

PROVIDER: S-EPMC5495116 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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Publications

Combined Anatomic Reconstruction of the Anterior Cruciate and Anterolateral Ligaments Using Hamstring Graft Through a Single Femoral Tunnel and With a Single Femoral Fixation.

Zein Assem Mohamed Noureldin AMN Ali Mohamed M Ali Hesham H Saleh Elsaid Ahmed Nady AN Mahmoud Alaa Zenhom AZ Osman Mohamed K MK Mohamed Soliman Amr Mohamed AM

Arthroscopy techniques 20170508 3

Patients with complete anterior cruciate ligament (ACL) injury have different degrees of rotational (internal rotation) laxity. A residual pivot shift has been found to be positive in more than 15% of cases after an accurate ACL reconstruction. Improved understanding of the existence, function, and biomechanical role of the anterolateral ligament (ALL) in controlling rotational instability of the knee has redirected and refocused attention on a supplemental extra-articular reconstruction of the ...[more]

PMID: 28706801

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Project description:Anterior cruciate ligament (ACL) injuries are among the most common lesions in orthopaedics practice, but still today, rates up to 24% of unsatisfactory results are reported. Unaddressed anterolateral complex (ALC) injuries have been claimed to be responsible for residual anterolateral rotatory instability (ALRI) after isolate ACL reconstruction and have demonstrated to increase graft failure. In this article, we present our technique for reconstruction of the ACL and anterolateral (ALL) ligament combining the advantages of the anatomical position and the intraosseous femoral fixation to ensure anteroposterior and anterolateral rotational stability. Technique Video Video 1 This video demonstrates our surgical technique for combined anatomic anterior cruciate ligament (ACL) and antero-lateral ligament (ALL) reconstruction. The knee is positioned, and examination under anaesthesia is performed confirming high-grade pivot shift. Medial and lateral landmarks are signed. A small anteromedial incision is performed, and semitendinosus and gracilis tendons are harvested using an open stripper. Care is taken to leave the distal insertion of both tendons intact. The two tendons are then whipstitched together at both extremities with high-resistance wires. Diameter is measured, and preparation of the graft is completed. On the lateral aspect of the knee, lateral femoral epicondyle, Gerdy’s tubercle and fibular head are identified and marked. A 3-cm incision is performed just posterior to the lateral epicondyle. Fascia lata is incised, and the anatomical femoral insertion of the anterolateral ligament is identified, proximal and posterior to the lateral epicondyle. With the help of an assistant, using an outside-in technique, a guide pin is positioned from the femoral insertion of the ALL to the femoral footprint of the ACL, and a tunnel of appropriate diameter is drilled. Tibial tunnel is then drilled using a standard technique. After positioning of the screw wire in the femoral socket, the graft is shuttled with two graspers through the tibial and femoral tunnels. After cyclic loading, femoral fixation is performed with the knee at 30° of flexion and neutral rotation. Lateral collateral ligament is identified and isolated, with the help of a curved forcep. The graft is then shuttled beneath the collateral ligament, from posterior to anterior. This can be done directly or with the help of a shuttling wire. A small vertical incision is performed, halfway between the Gerdy’s tubercle and the fibular head. With the help of a needle, the anatomic tibial insertion of the ALL is identified, about 10 mm below the articular surface. Fluoroscopy can be used for confirmation. The graft is passed underneath the fascia latae. Fixation of the graft in the tibial anatomical ALL insertion is performed with a low-profile staple, keeping the knee in full extension and neutral rotation. Finally, proper tension of the graft is demonstrated. If additional tension is required, the tibial portion of the ACL can be pulled using the distal whipstitch, and the tibial fixation can be added using an interference screw.

Dataset Information

Combined Anatomic Reconstruction of the Anterior Cruciate and Anterolateral Ligaments Using Hamstring Graft Through a Single Femoral Tunnel and With a Single Femoral Fixation.

Publications

Combined Anatomic Reconstruction of the Anterior Cruciate and Anterolateral Ligaments Using Hamstring Graft Through a Single Femoral Tunnel and With a Single Femoral Fixation.

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