Anatomic double-bundle anterior cruciate ligament reconstruction leaving hamstrings tibial insertion intact: technical n
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ORIGINAL ARTICLE
Anatomic double-bundle anterior cruciate ligament reconstruction leaving hamstrings tibial insertion intact: technical note Stefano Zaffagnini • Giulio Maria Marcheggiani Muccioli • Tommaso Bonanzinga Marco Nitri • Alberto Grassi • Maurilio Marcacci
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Received: 25 July 2012 / Accepted: 30 November 2012 / Published online: 12 December 2012 Ó Istituti Ortopedici Rizzoli 2012
Abstract This article describes an anatomic, double-bundle, arthroscopic anterior cruciate ligament reconstruction technique with hamstrings using second-generation out-in retrograde femoral drills, second-generation cortical femoral suspensory fixation devices with adjustable graft loop length, standard out-in tibial drills, and titanium low-profile tibial staples. Grafts choice is autologous gracilis and semitendinosus tendons. They are harvested through the single minimally invasive tibial incision maintaining their tibial insertion. Sutures are tightened at the free proximal tendon ends to obtain a sufficient strength to traction. The grafts are reflected in two separate loops and linked to femoral adjustable TightRope graft loops. With this method, grafts length can be customized to the anatomy of every knee and their tension can be increased even after graft fixation. The preservation of tendons tibial insertion could improve the neoligamentization process, acting as a tenodesis.
femoral tunnel placement in single-bundle reconstruction has shown to restore rotatory and anterior knee laxity similar to an anatomic reconstruction when the knee is near extension. However, this is not true throughout all the range of knee flexion [2]. In recent years, the better knowledge of ACL anatomy and function led to the development of several doublebundle techniques with the aim of closely replicating the original ACL biomechanics and improving the control of rotatory laxity [3–6]. We present an anatomic double-bundle technique that allows not only to better control rotatory laxity, but permits to restore proximo-distal laxity maintaining intact hamstrings tibial insertion. This was possible adopting the technical benefits offered by second-generation cortical suspensory fixation devices.
Keywords Knee Arthroscopy Single-incision Anterior cruciate ligament reconstruction Hamstrings Double-bundle
Surgical technique
Introduction Biomechanical studies have shown that ACL single-bundle reconstruction is successful in limiting anterior tibial translation but is insufficient in controlling a combined rotatory load of internal and valgus torque [1]. Lateral
S. Zaffagnini (&) G. M. Marcheggiani Muccioli T. Bonanzinga M. Nitri A. Grassi M. Marcacci Laboratorio di Biomeccanica, Istituto Ortopedico Rizzoli, via di Barbiano, 1/10, 40100 Bologna, Italy e-mail: [email protected]
Surgery is performed under general or spinal anesthesia, with the patient placed in a supine position on the operating table. After pneumatic tourniquet positioning (insufflated to 300 mmHg) and preparation of the leg in the normal sterile f
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