Anterior Cruciate Ligament Reconstruction: Single-­Bundle Transtibial Technique


Anterior Cruciate Ligament Reconstruction: Single-­Bundle Transtibial Technique


Introduction



Patient Selection


Indications




  • Younger than 40 years with an active, athletic lifestyle


  • Other considerations—Type of sports involvement, hours per week played, concomitant meniscal pathology, failure of nonsurgical care, ability to participate in postoperative physical therapy


  • Delay surgery until postinjury effusion has fully resolved and patient has attained full range of motion.

Contraindications




  • Open physes


  • Symptomatic preoperative patellar tendon disease or patellar malalignment


  • Relative contraindications—Degenerative joint disease, sedentary lifestyle, inability to comply with postoperative rehabilitation protocol

Preoperative Imaging







Video 16.1 Anterior Cruciate Ligament Reconstruction: Single-­Bundle Transtibial Technique. Eric J. Strauss, MD; Adam Yanke, MD; Bernard R. Bach, Jr, MD (19 min)

Procedure


Room Setup/Patient Positioning




  • Supine position; waist of operating table is reflexed to reduce lumbar extension.


  • Examination under anesthesia


    • Lachman test


    • Varus/valgus knee stability


    • Pivot shift test; if positive, BPTB graft harvest can proceed before diagnostic arthroscopy.


    • Assessment of posterolateral corner


  • Tourniquet applied (rarely inflated)


  • Contralateral leg in gynecological leg holder


  • Surgical leg in arthroscopic leg holder with foot of table flexed completely to allow the surgical knee to flex to at least 110°

Special Instruments/Equipment/Implants



Surgical Technique


Graft Harvest


image

Figure 1Intraoperative photograph shows a central-­third bone–patellar tendon–bone autograft harvest using a No. 10 scalpel blade starting on the patella and continuing into the patellar tendon.

May 13, 2023 | Posted by in Uncategorized | Comments Off on Anterior Cruciate Ligament Reconstruction: Single-­Bundle Transtibial Technique

Full access? Get Clinical Tree

Get Clinical Tree app for offline access