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Author Spotlight: Implementing the Enhanced Recovery After Surgery Concept in Rehabilitation Following Anterior Cruciate Ligament Reconstruction

Author Spotlight: Implementing the Enhanced Recovery After Surgery Concept in Rehabilitation Following Anterior Cruciate Ligament Reconstruction

Published on: March 1, 2024

Modified Transtibial Technique for Anterior Cruciate Ligament Reconstruction with Quadriceps Tendon Autograft

Joon Kyu Lee¹, Sahnghoon Lee², Sang Cheol Seong²

¹Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, South Korea.

JBJS Essential Surgical Techniques

|February 19, 2019

Abstract

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.IndicationsContraindicationsPitfalls & Challenges.

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