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The technique of quadrupled semitendinosus autograft for ACL reconstruction using the EndoButton for femoral fixation has been described. Dr. Rosenberg, this article's senior author, has used this for over 10 years with no known instance of fixation failure at the femur or tibia. This technique using QST reconstruction has little morbidity, low reoperation rate, and excellent clinical results.
Current tibial endoscopic ACL reconstruction techniques provide functional stability, but fall short of the ultimate goal of ACL reconstruction, to restore normal knee kinematics. Vertical graft placement results in restoration of normal anteroposterior stability with a negative Lachman exam, but may not produce a stable knee in rotation, noted by a positive pivot shift. The Clancy anatomic endoscopic ACL reconstruction technique utilizes flexible reamers to achieve anatomic graft placement to more closely reproduce normal knee function. The overall results of arthroscopic anatomic endoscopic ACL reconstruction are essentially the same as we have reported using our previous open and rear-entry, two-incision techniques for anatomic graft placement. The long-term benefits of a more physiologic single incision endoscopic ACL reconstruction are not yet determined; however, short-term results are encouraging.
Historically, the two-incision technique for anterior cruciate ligament (ACL) reconstruction was the standard of practice. It allows predictable, near-anatomic placement of the femoral tunnel and provides highly reproducible results with few complications. There are several major advantages of the two-incision technique over endoscopic methods. These include consistent femoral tunnel placement, elimination of concern for "blowing out the back wall," elimination of the problem of graft-tunnel mismatch, elimination of the problem of screw divergence, and ease of use for revision ACL reconstruction procedures. The angle of the ACL graft is also more anatomic, matching the angle of the native ACL. In this chapter we present our technique for reconstruction of the ACL using the two-incision approach. Indications for its use are discussed. Advantages and disadvantages of the two-incision method compared with the all-endoscopic approach are reviewed.
The patella tendon is the most commonly used graft source for ACL reconstruction because of its biomechanical strength and stiffness, the availability of bone-to-bone healing on either end, and the ability to firmly secure the graft within the tunnels. Consistently good results have been reported in the literature, with expectations to return to all activities at pre-injury levels of performance. We outline our technique for endoscopic ACL reconstruction using a patella tendon autograft. The technique is divided into the critical stages of pre-operative assessment, graft harvest, notch preparation, tunnel placement, graft passage, graft fixation, and rehabilitation. Methods for avoiding pitfalls and overcoming mishaps are described.
It is generally accepted that meniscus repair in a knee with persistent anterior cruciate ligament (ACL) insufficiency leads to a higher retear rate, and that meniscal repair in conjunction with ACL reconstruction is associated with a higher rate of meniscal healing compared with patients who do not undergo ACL reconstruction. In this article, we will review the background of thses concepts and present treatment strtegies for meniscal tears in ACL-insufficient knees, with particular attention to meniscal repair and meniscal allograft transplanatation.
INTRODUCTION: We report a case of donor site morbidity late after harvesting a free fibular flap for reconstruction of the mandibular symphsis. CASE REPORT: An 8-year-old boy presented a valgus deformity of the ankle 4 years harvesting of a vascularized fibular graft for mandibular reconstruction. The deformation was repaired with a tibial bone slit and pin fixation. The biomechanical result was very satisfactory, allowing normal gait. DISCUSSION: We recall the rules for fibular flap harvesting needed to prevent deformation of the donor site in children aged less than 9 years.
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