NEW SURGICAL TECHNIQUE
By Fabio Conteduca, MD and Andrea Ferretti, MD
The procedure begins with a standard knee arthroscopy, in order to evaluate arthicular pathologies. Possible meniscal tears are treated and the ACL stump is removed.
After removing the scope a 3 centimeter long incision over the groose-foot is made in order to harvest semitendinosus and gracilis hamstring. By an open tendon stripper both hamstring are released up to their junction Once having removed the remaining muscular fibers the tendons are completely detached from the distal insertion.
The external lateral femoral condyle portion is prepared from a second external incision 3 cm. long.
The scope is then inserted again and the tibial and femoral tunnels are drilled according to the standard techniques.
Hamstrings are then prepared with the Swing Bridge. The free tendons are driven across the ring of the device and are pulled from the lateral incision through the femoral tunnel into the joint.
The metallic cylinder, dragged down by the hamstring while they are pulled out is forced to partially fit the external side of the femoral tunnel. Using the proper designed impactor, the cylinder is completely inserted in the femoral tunnel until the shelf reach the external femoral cortical bone.
A proper traction of the hamstring loose ends, together with several flexion extensions of the knee will allow the hamstring to slide on the metallic ring like a pulley, equally pretensioning in this way the four bundles. Two staples are then inserted across the tendon close to the distal edge of the tibial tunnel. So far, a good knee stability is already obtained with negative laxity tests which can be performed without any risk of losing tension.
Final Tensioning Of The Graft :.
However this device allows a second and final tensioning by winding the bundles. In fact the cylinder can be rotated of 360° or more (clockwise for the right knees, opposite for the left) with a properly designed screw driver inserted in the four splines on the external side of the shelf.
The neo ligament is monitored by the scope while rotating. In this way we obtain a final controlled tension.
Tension is manually detectable with a probe inside the joint. In this way and we can easily obtain the desired and more reproducible tension. The Swing Bridge can be rotated many times until a satisfactory tension is obtained, but we suggest that the range 360°-720° will not over tension the graft.
By using this technique we can obtain the following:
1) A direct final intraarticular ligament pretensioning and tensioning
2) A controlled tension
3) A more easy reproducible tension
4) No changes between pretensioning procedure and fixation
Click here for more information about pretensioning.
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