Intraarticular ACL reconstruction using the patellar tendon: arthroscopic technique

Braided hamstring tendons for reconstruction of the anterior cruciate ligament. A biomechanical analysis

BACKGROUND

In an effort to improve the strength and stiffness of anterior cruciate ligament grafts, several authors have advocated alterations of graft structure and orientation, including braiding the tendons in hamstring tendon grafts.

HYPOTHESIS

Braiding hamstring tendons does not increase graft strength and stiffness.

STUDY DESIGN

Controlled laboratory study.

METHODS

Sixteen hamstring tendon and 21 bone-patellar tendon-bone grafts were harvested from 12 cadavers and divided into three groups: 1) braided four-strand hamstring tendon, 2) unbraided four-strand hamstring tendon, and 3) bone-patellar tendon-bone. All grafts were placed under a 50-N preload on a servohydraulic testing device and were tensioned to failure.

RESULTS

The strength and stiffness of the tested specimens averaged 427 +/- 36 N and 76 +/- 10 N/mm, respectively, for braided specimens, 532 +/- 44 N and 139 +/- 18 N/mm for unbraided specimens, and 574 +/- 46 N and 158 +/- 15 N/mm for patellar tendon specimens. There was a 20% decrement in hamstring tendon graft tensile strength and a 45% decrease in stiffness after braiding because of the suboptimal multidirectional orientation of individual tendons within the braided grafts.

CONCLUSIONS

In vitro braided hamstring tendon grafts demonstrated mechanically inferior strength and stiffness characteristics compared with unbraided hamstring tendon grafts and patellar tendon grafts.

CLINICAL RELEVANCE

Braiding of hamstring tendon grafts provides no mechanical advantage in anterior cruciate ligament reconstruction.

Consistent and accurate graft passage and interference screw guide wire placement during single incision anterior cruciate ligament reconstruction

Misplacement and misalignment of trocar pins and guide wires during single-incision anterior cruciate ligament reconstructions can lead potentially to a number of complications. These complications include unacceptable trocar pin exit locations, difficulty repositioning the trocar pin along the initial track after unsuccessful attempts at graft passage, as well as guide wire impingement and graft transection during interference screw advancement. To help overcome these complications, a surgical technique using an eccentric aimer and two-pin passer was developed to help provide precise and repeatable placement of both a trocar pin and guide wire.

Arthroscopically assisted reconstruction of the anterior cruciate ligament: initial clinical experience and minimal 2-year follow-up comparing endoscopic transtibial and two-incision techniques

The purpose of this study was to determine the outcome of endoscopic Anterior Cruciate Ligament (ACL) reconstruction and assess whether this technique modification offers any significant advantages over arthroscopically assisted reconstruction. A consecutive series of 90 athletically-active patients (67 males, 23 females) who underwent reconstruction for ACL deficiency using a patellar tendon autograft was retrospectively reviewed. The study group consisted of two treatment subgroups: Group 1-EA (Endoscopic-Assisted technique using no lateral femoral condylar incision) consisted of 45 patients with a mean age of 25 years (range 15 to 43 and Group 2-AA (Arthroscopic-Assisted technique using both anterior and lateral femoral condylar incisions) consisted of 45 patients with a mean age of 25 years (range 16 to 37). The study groups were evaluated at specific postoperative intervals with a mean follow-up in Group 1-EA of 30 months (range 24-37) and in Group 2-AA, 41 months (range 24 to 77). Serial KT-1000 results averaged 2 mm in both groups with 75% of Group 1-EA and 78% in Group 2-AA patients noted to have < or = 3 mm side-to-side differences. No statistically significant differences were noted for complications including patellofemoral pain, arthrofibrosis, harvest site pathology, or painful hardware. At ultimate follow-up however, this study suggests that both methods may result in similar and reproducible satisfactory outcome.

Patellar tendon graft harvesting using horizontal incisions for anterior cruciate ligament reconstruction

Autograft endoscopic anterior cruciate ligament (ACL) reconstruction traditionally has been performed via standard arthroscopy portals and a single longitudinal anterior incision. This vertical incision is used for harvesting the central third of the patellar tendon with patellar and tibial bone blocks. From 1992 to 1995, more than 400 cases have been done with a new technique of graft procurement. This new method employs two transverse incisions that are more cosmetic and are less likely to become a source of pain or flexion limitation.