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Latest Surgical Technique

May 08, 2013

All-Inside, All-Epiphyseal Autograft Reconstruction of the Anterior Cruciate Ligament in the Skeletally Immature Athlete

by Peter D. Fabricant, MD, MPH; Moira M. McCarthy, MD; Frank A. Cordasco, MD, MS; Daniel W. Green, MD, MS

Overview

Introduction

We present an all-inside, all-epiphyseal anterior cruciate ligament (ACL) reconstruction technique with use of a hamstring autograft for skeletally immature athletes.

Step 1: Identify Subcutaneous Landmarks

Identify and mark subcutaneous landmarks to aid with anatomic orientation throughout the operation and to assist with socket placement.

Step 2: Harvest the Hamstring Graft

Harvest a hamstring autograft to create a four-strand autograft in the standard fashion or, if you prefer, perform a posterior hamstring harvest.

Step 3: Prepare the Graft

Prepare a four-strand hamstring autograft using suspensory cortical fixation devices—a reverse-tensioning button (ACL TightRope RT; Arthrex, Naples, Florida) on the femoral side and an attachable button system (ACL TightRope ABS, Arthrex) on the tibial side.

Step 4: Prepare the Femoral and Tibial Sockets

Create blind-ended intra-articular sockets in the femur and tibia using the center-center footprint positions while avoiding the physeal plates.

Step 5: Pass and Secure the Graft

Pass the hamstring autograft through the anteromedial portal and dock it in the femoral and tibial sockets; engage the cortical button on the femur, dock the graft, and then perform final fixation on the tibial side.

Step 6: Postoperative Rehabilitation

The patient’s age and maturity level dictate the progression of rehabilitation, and parents and caregivers are encouraged to regularly participate in the child’s rehabilitation regimen.

Results

Research is ongoing to evaluate the clinical and radiographic outcomes following ACL reconstruction in skeletally immature athletes with use of this technique19.

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Indications

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More Surgical Techniques

March 27, 2013

Dual Growing Rods for the Treatment of Early-Onset Scoliosis

by Gregory M. Mundis, MD; Nima Kabirian, MD; Behrooz A. Akbarnia, MD

March 13, 2013

Distal Rectus Femoris Tendon Transfer for the Correction of Stiff-Knee Gait in Cerebral Palsy

by T. Dreher, MD; F. Braatz, MD; S.I. Wolf, PhD; V. Ewerbeck, MD; D. Heitzmann, MSc; W. Wenz, MD; L. Döderlein, MD

February 27, 2013

Surgical Treatment of Overcorrected Clubfoot Deformity

by Markus Knupp, MD; Alexej Barg, MD; Lilianna Bolliger, MSc; Ashley L. Kapron, BS; Beat Hintermann, MD

February 13, 2013

Anatomic, Transepiphyseal Anterior Cruciate Ligament Reconstruction

by Kyle E. Hammond, MD; John W. Xerogeanes, MD; Dane C. Todd, MD

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Recently Published in The Journal of Bone & Joint Surgery:

Adverse Local Tissue Reaction Arising from Corrosion at the Femoral Neck-Body Junction in a Dual-Taper Stem with a Cobalt-Chromium Modular Neck

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Intra-Articular Metastasis of Lung Carcinoma Presenting as Pigmented Villonodular Synovitis of the Knee: A Case Report

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03/20/2013 Sentara Hand Surgery Specialists seek a Top Orthopaedic Fellowship Trained Hand Surgeon VA - Sentara Medical Group	04/17/2013 PROFESSOR AND VICE-CHAIR FOR RESEARCH TX - UT Health
04/17/2013 Joint Reconstruction, Foot/ Ankle and Trauma CT - Yale University School of Medicine	05/01/2013 Hershey, PA Academic Orthopaedic Surgeon PA - Penn State Milton S. Hershey Medical Center