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.
Pitfalls & Challenges
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.
Anatomic positioning of the tunnels in ACL reconstruction has proved to be better in terms of knee stability and …
Enter your JBJS login information below.