Abstract
We propose that the tibial remnant of the anterior cruciate ligament (ACL) is able
to enhance the revascularization and cellular proliferation of the graft, to preserve
proprioceptive function, and to be able to acquire anatomic placement of the graft
without roof impingement. Therefore, it seems reasonable to assume that preserving
the tibial remnant as much as possible as a source of reinnervation, if technically
possible without causing impingement, would be of potential benefit to the patient.
Our surgical technique was developed to maximize the preservation of the tibial remnant.
The distally attached semitendinosus and gracilis tendons are harvested using the
tendon stripper. After satisfactory placement of 2 guide pins convergently, a closed-end
socket in the lateral femoral condyle is created using an adequately sized curved
curette. For anatomic placement of the graft, the tibial tunnel should be positioned
within the boundaries of the normal ACL tibial remnant. The reamer must be advanced
very carefully to minimize injury to the residual remnant at the intra-articular margin
of the tibial tunnel. Penetration should stop at the base of the stump. The folded
grafts are then pulled intra-articularly through the tibial tunnel, the tibial remnant,
and the femoral socket by pulling sutures under arthroscopic visualization. The ACL
tibial remnant is compacted by the tendon passage. The graft is secured proximally
by tying sutures in the lateral femoral condyle and distally at the tibia with double
staples by a belt-buckle method. The advantages of our technique include maximal preservation
of the tibial remnant, no roof impingement caused by intrasynovial anatomic placement
of the graft, the simplicity of the procedure, the minimal need for hardware or special
instruments, the economic benefit, and the potential prevention of tibial tunnel enlargement
by preventing synovial fluid leakage.
Key Words
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Article info
Footnotes
Cite this article as: Lee B-I, Min K-D, Choi H-S, Kim J-B, Kim ST. Arthroscopic anterior cruciate ligament reconstruction with the tibial-remnant preserving technique using a hamstring graft. Arthroscopy 2006;22:340e.1-340e.7 [doi:10.1016/j.arthro.2005.11.010].
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Copyright
© 2006 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
