Kyle E Hammond1, John W Xerogeanes2, Dane C Todd2. 1. Emory Orthopaedics, 704 North Superior Avenue, Decatur, GA 30033. E-mail address: kehammond6@gmail.com. 2. Emory Orthopaedic and Spine Center, 59 Executive Park South, Suite 1000, Atlanta, GA 30329. E-mail address for J.W. Xerogeanes: john.xerogeanes@emory.edu. E-mail address for D.C. Todd: dctodd@emory.edu.
Abstract
INTRODUCTION: Our technique for physeal-sparing, anatomic anterior cruciate ligament (ACL) reconstruction reliably produces femoral tunnels that are of adequate length and that safely avoid the femoral physis without the addition of time-consuming surgical methods or substantial utilization of fluoroscopy. STEP 1 PREOPERATIVE PLANNING: Obtain radiographs and MRI of the knee as well as an anteroposterior radiograph of the hand (to obtain a bone age). STEP 2 PATIENT SETUP PORTAL PLACEMENT AND GRAFT HARVEST: The affected knee must be able to flex at least 90° with the end of the operative table lowered, in order to properly visualize the anatomy of the ACL femoral footprint. STEP 3 PREPARE ACL FOOTPRINT AND ESTABLISH FAR ANTEROMEDIAL PORTAL: Maintain soft-tissue remnants at both the femoral and the tibial footprint in order to individualize the anatomy. STEP 4 IDENTIFY EXTRA-ARTICULAR LANDMARKS AND PREPARE FEMORAL TUNNEL: Visualize and palpate your previously marked popliteal sulcus and lateral epicondyle; these landmarks are the crucial extra-articular points for establishing a safe femoral tunnel. STEP 5 PREPARE TIBIAL TUNNEL: The tibial tunnel can be safely drilled in a transphyseal manner in skeletally immature patients. STEP 6 FIX GRAFT: Use the Arthrex ACL TightRope RT for femoral fixation. STEP 7 POSTOPERATIVE CARE: As a skeletally immature athlete differs from a more mature athlete in several important ways, alter the postoperative protocol accordingly. RESULTS: Our clinical experience has corresponded to our MRI-based findings from our original study14, and we have not observed any physeal or chondral injuries leading to growth disturbances from our femoral tunnels. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: Our technique for physeal-sparing, anatomic anterior cruciate ligament (ACL) reconstruction reliably produces femoral tunnels that are of adequate length and that safely avoid the femoral physis without the addition of time-consuming surgical methods or substantial utilization of fluoroscopy. STEP 1 PREOPERATIVE PLANNING: Obtain radiographs and MRI of the knee as well as an anteroposterior radiograph of the hand (to obtain a bone age). STEP 2 PATIENT SETUP PORTAL PLACEMENT AND GRAFT HARVEST: The affected knee must be able to flex at least 90° with the end of the operative table lowered, in order to properly visualize the anatomy of the ACL femoral footprint. STEP 3 PREPARE ACL FOOTPRINT AND ESTABLISH FAR ANTEROMEDIAL PORTAL: Maintain soft-tissue remnants at both the femoral and the tibial footprint in order to individualize the anatomy. STEP 4 IDENTIFY EXTRA-ARTICULAR LANDMARKS AND PREPARE FEMORAL TUNNEL: Visualize and palpate your previously marked popliteal sulcus and lateral epicondyle; these landmarks are the crucial extra-articular points for establishing a safe femoral tunnel. STEP 5 PREPARE TIBIAL TUNNEL: The tibial tunnel can be safely drilled in a transphyseal manner in skeletally immature patients. STEP 6 FIX GRAFT: Use the Arthrex ACL TightRope RT for femoral fixation. STEP 7 POSTOPERATIVE CARE: As a skeletally immature athlete differs from a more mature athlete in several important ways, alter the postoperative protocol accordingly. RESULTS: Our clinical experience has corresponded to our MRI-based findings from our original study14, and we have not observed any physeal or chondral injuries leading to growth disturbances from our femoral tunnels. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
Authors: John C Loh; Yukihisa Fukuda; Eiichi Tsuda; Richard J Steadman; Freddie H Fu; Savio L Y Woo Journal: Arthroscopy Date: 2003-03 Impact factor: 4.772