Allograft anterior cruciate ligament reconstruction with patellar tendon: An endoscopic technique

Abstract

The endoscopic technique for anterior cruciate ligament (ACL) reconstruction with a patellar tendon allograft has been used since 1990 in an attempt to minimize the morbidity associated with surgery. We use allografts that have been harvested under strict sterile conditions, deep frozen, and then thawed in a warm antibiotic solution just before the procedure. After the diagnostic arthroscopy, attention to the menisci, and removal of the ACL stump (leaving enough of the “footprint” on the tibia to facilitate the tunnel placements), a notchplasty is performed. A point 5 to 6 mm distal to the “over-the-top” position is marked (distance should be equal to one half the diameter of the bone plug endoscopically placed in the femoral tunnel). A “longer” tibial tunnel is prepared because the tibial plug is located just within the tunnel on the intra-articular side of the femur several centimeters distal to the standard location. The femoral tunnel is prepared with the knee flexed 90° over the edge of the table. The Beath pin with no. 0 Ethibond sutures is advanced through the tunnel under direct arthroscopic visualization and out the anterolateral thigh. The sutures are used to pull the graft through the tibial tunnel and to pull the tibial plug into the femoral tunnel. The patellar plug is advanced into the tibial tunnel with a bone tamp. The graft is tensioned and fixed with Kurosaka-type interference screws. Tests are performed to verify tension and absence of impingement. The tourniquet is released. Sterile dressings and an immobilizer (to keep the knee in full extension) are applied and kept in place until the sutures are removed 5 to 7 days postoperatively.