Joon Kyu Lee1, Sahnghoon Lee2, Sang Cheol Seong2, Myung Chul Lee2. 1. Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, South Korea. 2. Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea. E-mail address for M.C. Lee: leemc@snu.ac.kr.
Abstract
INTRODUCTION: The modified transtibial technique with quadriceps tendon autograft allows anatomic anterior cruciate ligament (ACL) reconstruction without tunnel widening and results in a stable and functional knee with a satisfactory clinical outcome. STEP 1 PREPARE THE PATIENT: Prepare the patient under spinal anesthesia with the usual arthroscopic setting. STEP 2 ARTHROSCOPIC EXAMINATION: Perform arthroscopic examination to confirm the ACL rupture and other intra-articular lesions. STEP 3 HARVEST THE QUADRICEPS TENDON: Harvest the central one-third of the quadriceps tendon strip with a proximal patellar bone block. STEP 4 PREPARE THE QUADRICEPS TENDON GRAFT: Prepare the quadriceps tendon graft to pass smoothly through the tunnels. STEP 5 SET THE TIBIAL TUNNEL ENTRY POINT: Make a 3-cm longitudinal skin incision at the anteromedial aspect of the proximal part of the tibia. STEP 6 CREATE THE TIBIAL TUNNEL: Drill a 10-mm tibial tunnel. STEP 7 TARGET THE FEMORAL TUNNEL STARTING POINT: Aim the guide at the lateral bifurcate ridge on the medial wall of the lateral femoral condyle with the modified transtibial technique. STEP 8 CREATE THE FEMORAL TUNNEL: Drill a 10-mm femoral tunnel. STEP 9 FIX THE GRAFT: Fix the graft with adequate tension. STEP 10 POSTOPERATIVE REHABILITATION: Rehabilitate the patient step by step. RESULTS: In a study that compared fifty-two patients managed with a modified transtibial technique and another fifty-two patients managed with an anteromedial transportal technique, there were no significant differences in the clinical results in terms of manual laxity, arthrometric analysis, and subjective outcome.IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: The modified transtibial technique with quadriceps tendon autograft allows anatomic anterior cruciate ligament (ACL) reconstruction without tunnel widening and results in a stable and functional knee with a satisfactory clinical outcome. STEP 1 PREPARE THE PATIENT: Prepare the patient under spinal anesthesia with the usual arthroscopic setting. STEP 2 ARTHROSCOPIC EXAMINATION: Perform arthroscopic examination to confirm the ACL rupture and other intra-articular lesions. STEP 3 HARVEST THE QUADRICEPS TENDON: Harvest the central one-third of the quadriceps tendon strip with a proximal patellar bone block. STEP 4 PREPARE THE QUADRICEPS TENDON GRAFT: Prepare the quadriceps tendon graft to pass smoothly through the tunnels. STEP 5 SET THE TIBIAL TUNNEL ENTRY POINT: Make a 3-cm longitudinal skin incision at the anteromedial aspect of the proximal part of the tibia. STEP 6 CREATE THE TIBIAL TUNNEL: Drill a 10-mm tibial tunnel. STEP 7 TARGET THE FEMORAL TUNNEL STARTING POINT: Aim the guide at the lateral bifurcate ridge on the medial wall of the lateral femoral condyle with the modified transtibial technique. STEP 8 CREATE THE FEMORAL TUNNEL: Drill a 10-mm femoral tunnel. STEP 9 FIX THE GRAFT: Fix the graft with adequate tension. STEP 10 POSTOPERATIVE REHABILITATION: Rehabilitate the patient step by step. RESULTS: In a study that compared fifty-two patients managed with a modified transtibial technique and another fifty-two patients managed with an anteromedial transportal technique, there were no significant differences in the clinical results in terms of manual laxity, arthrometric analysis, and subjective outcome.IndicationsContraindicationsPitfalls & Challenges.
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