Anatomic Double Bundle Single Tunnel Foreign Material Free ACL-Reconstruction - a Technical Note

Overview

Journal Muscles Ligaments Tendons J

Date 2013 Jun 6

PMID 23738263

Citations 6

Authors

Gernot Felmet

Affiliations

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Abstract

Unlabelled: The anterior cruciate ligament (ACL) consists of two bundles, the anteromedial (AM) and posterolateral bundle (PM). Double bundle reconstructions appear to give better rotational stability. The usual technique is to make two tunnels in the femur and two in the tibia. This is difficult and in small knees may not even be possible. We have developed a foreign material free press fit fixation for double bundle ACL reconstruction using a single femoral tunnel ((R)). This is based on the ALL PRESS FIT ACL reconstruction. It is suitable for the most common medium and, otherwise difficult, small sizes of knees.

Method: Using diamond edged wet grinding hollow reamers, bone cylinders in different diameters are harvested from the implantation tunnels of the tibia and femur and used for the press fit fixation. Using the press fit technique the graft is first fixed in tibia. It is then similarly fixed under tension in the femoral side with the knee in 120 degree flexion. This is called Bottom To Top Fixation (BTT). On extending the knee the graft tension is self adapting. Depending on the size of the individual knee, the diameter of the femoral bone plug is varied from 8 to 13 mm to achieve an anatomic spread with a double bundle-like insertion. The tibia tunnel can be applied with two 7 or 8 mm diameter tunnels overlapping to a semi oval tunnel between 10 to 13 mm.

Results: Since May 2003 we have carried out ACL-reconstructions with Hamstring grafts without foreign material using the ALL PRESS FIT technique. Initially, an 8 mm press fit fixation was used proximally with good results. Since April 2008, the range of diameters was increased up to 13 mm. The results of the Lachman tests have been good to excellent. Results of the Pivot shift test suggested more stability with femoral broader diameters of 9,5 to 13 mm.

Conclusions: The foreign material free fixation of ham-string in the ALL PRESS FIT Bottom To Top Fixation is a successful method for ACL Reconstruction. The Diamond Instruments and tubed guiding devices are precise, reliable and easy to manage. On this basis a double bundle reconstruction is achieved using a single tunnel. A broad anatomic femoral insertion with autogenous bone plugs inserted near the cortex seems to improve rotational stability.

Citing Articles

Re-rupture rate and the post-surgical meniscal injury after anterior cruciate ligament reconstruction with the Press-Fit-Hybrid®-technique in comparison to the interference screw technique: a retrospective analysis of 200 patients with at least....

Volz R, Borchert G Arch Orthop Trauma Surg. 2022; 143(2):935-949.

PMID: 35290503 PMC: 9925573. DOI: 10.1007/s00402-022-04368-7.

Quadriceps and hamstring tendon autografts in ACL reconstruction yield comparably good results in a prospective, randomized controlled trial.

Horstmann H, Petri M, Tegtbur U, Felmet G, Krettek C, Jagodzinski M Arch Orthop Trauma Surg. 2021; 142(2):281-289.

PMID: 33742222 PMC: 8783919. DOI: 10.1007/s00402-021-03862-8.

Changing the Diameter of the Bone Tunnel Is More Effective Than Changing the Tunnel Shape for Restoring Joint Functionality After ACL Reconstruction.

Wang H, Zhang M, Cheng C Front Bioeng Biotechnol. 2021; 8:173.

PMID: 33490045 PMC: 7819500. DOI: 10.3389/fbioe.2020.00173.

Analysis of modified double-bundle anterior cruciate ligament reconstruction with implantless fixation on tibial side.

Sinha S, Naik A, Kumar A, Jacob T, Kar S Chin J Traumatol. 2020; 23(6):341-345.

PMID: 32417042 PMC: 7718536. DOI: 10.1016/j.cjtee.2020.04.007.

In vivo bone tunnel remodeling in symptomatic patients after ACL reconstruction: a retrospective comparison of articular and extra-articular fixation.

Mathis D, Rasch H, Hirschmann M Muscles Ligaments Tendons J. 2016; 5(4):316-24.

PMID: 26958543 PMC: 4762646. DOI: 10.11138/mltj/2015.5.4.316.

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