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. 2013 Mar 24;2(2):e99-e104.
doi: 10.1016/j.eats.2012.12.002. Print 2013 May.

Anatomic All-Inside Anterior Cruciate Ligament Reconstruction Using the Translateral Technique

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Free PMC article

Anatomic All-Inside Anterior Cruciate Ligament Reconstruction Using the Translateral Technique

Adrian J Wilson et al. Arthrosc Tech. .
Free PMC article

Abstract

There is growing evidence that anatomic placement of the femoral tunnel in anterior cruciate ligament reconstruction confers biomechanical advantages over the traditional tunnel position. The anteromedial portal technique for anatomic anterior cruciate ligament reconstruction has many well-described technical challenges. This article describes the translateral all-inside technique, which produces anatomic femoral tunnel placement using direct measurement of the medial wall of the lateral femoral condyle and outside-in drilling. All work is carried out through the lateral portal with all viewing through the medial portal. Thus there is no need for an accessory medial portal or hyperflexion of the knee during femoral socket preparation. A single quadrupled hamstring graft is used with cortical fixation at both the femoral and tibial tunnels.

Figures

Fig 1
Fig 1
(A) Curved marking/measuring device. This instrument allows direct measurement of the medial wall of the lateral femoral condyle and anatomic positioning of the femoral tunnel. (B) Measuring from low position: the view is of the medial wall of the lateral femoral condyle of the left knee from the AM portal with the knee at 90° of flexion. The height of the center of the femoral tunnel is 2 mm plus the radius of the tunnel above the low articular margin. (C) Close-up of measuring arm. (D) Measuring deep to shallow or front to back of notch. The anatomic or midbundle position is halfway from the deep to the shallow articular cartilage. Again, the view is from the AM portal at 90° of flexion.
Fig 2
Fig 2
Translateral portal positions. This shows the left knee at 90° of flexion with traditional and translateral portals. The translateral portals are noticeably lower and more central than the traditional portals.
Fig 3
Fig 3
Quadrupled semitendinosus tendon with 2 ACL TightRopes, forming a modified GraftLink construct. A single semitendinosus tendon is harvested through a curved incision over the pes anserinus. The tendon is loaded onto 2 adjustable suspensory TightRope RT devices and quadrupled to form the modified GraftLink construct.
Fig 4
Fig 4
Medial aspect of lateral femoral condyle. The anatomic footprint of the native ACL is shown, as are the graft tunnel and measurements. The position of the femoral tunnel is in the anatomic midbundle position. Reprinted with permission. (PL, posterolateral.)
Fig 5
Fig 5
Arthroscopic view of direct measurement of medial aspect of lateral femoral condyle with marking/measuring tool. All the arthroscopic images are of a left knee in 90° of flexion through the AM portal. (A) Measuring deep to shallow. (B) Measuring shallow articular cartilage to center of femoral footprint. This point lies halfway between the deep and shallow articular cartilage. (C) Measuring from low articular cartilage along line of bifurcate ridge. The height of the center of the femoral tunnel is 2 mm plus the radius of the femoral tunnel above the low articular cartilage.
Fig 6
Fig 6
Caliblator curved RF device. (A) Measuring deep to shallow. (B) Measuring shallow articular cartilage to center of femoral footprint, which lies halfway between deep and shallow articular cartilage. (C) Measuring from low articular cartilage along line of bifurcate ridge. The height of the center of the femoral tunnel is 2 mm plus the radius of the femoral tunnel above the low articular cartilage.
Fig 7
Fig 7
Arthroscopic images of femoral tunnel preparation. Images show a left knee at 90° of flexion through the AM portal. (A) Aiming jig in position at anatomic midbundle point. This can be confirmed by the calibrations on the jig arm. (B) View of femoral tunnel. (C) Confirming tunnel position with measuring tool.

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