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, 3 (2), e265-9
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Anatomic Outside-In Anterior Cruciate Ligament Reconstruction Using a Suspension Device for Femoral Fixation

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Anatomic Outside-In Anterior Cruciate Ligament Reconstruction Using a Suspension Device for Femoral Fixation

Alejandro Espejo-Baena et al. Arthrosc Tech.

Abstract

Cortical suspension is one of the most frequently used methods of femoral fixation in anterior cruciate ligament reconstruction. We present a simple technique for anterior cruciate ligament reconstruction using a suspension device for femoral fixation. The purposes of this technique are to ensure greater contact between the graft and the tunnel walls-a goal that is achieved by using the femoral fixation device with the shortest possible loop-to avoid the flip step and the need for hyperflexion, and in short, to minimize the risk of complications that can occur when using the anteromedial portal to drill the femoral tunnel. To this end, both the femoral and tibial tunnels are created in an outside-in manner and with the same guide. The graft is passed through in a craniocaudal direction, and the suspension device is fitted inside an expansion piece for a better adaptation to the femoral cortex.

Figures

Fig 1
Fig 1
Diagram of technique (right knee). Femoral fixation is achieved with a suspension device engaged in its expansion piece; a minimal loop is used to allow longer contact between the tunnel walls and the graft. Tibial fixation is performed with an interference screw of the longest possible length.
Fig 2
Fig 2
(A) The patient's limb is placed in a leg holder with the knee flexed to 90° (lateral view of right knee). (B) The central and anteromedial portals are used (right knee).
Fig 3
Fig 3
Prepared graft. The free ends are stitched together. The graft loop is placed onto the femoral fixation device (red arrow), which in turn is attached to a second device to increase its length (yellow arrow).
Fig 4
Fig 4
Guide used to create both tunnels. The only condition is that the guide must be adjustable to at least 80°.
Fig 5
Fig 5
Positioning of guide for femoral tunnel (right knee). The guide is inserted into the joint through the central portal and must be adjustable to at least 80°. The arthroscope is inserted through the anteromedial portal.
Fig 6
Fig 6
The location of the center of the femoral tunnel (view from transtendinous portal, showing medial aspect of lateral condyle) is set at the midpoint of a line drawn parallel to the posterior margin of the lateral femoral condyle at a distance of 2.5 mm plus the tunnel radius from said margin.
Fig 7
Fig 7
Positioning of guide for tibial tunnel. The arthroscope is inserted through the central portal and the guide, set at 55°, through its anteromedial counterpart.
Fig 8
Fig 8
The graft is pulled in a craniocaudal direction through the femoral tunnel, exiting through its tibial counterpart (a reversal of the conventional technique).
Fig 9
Fig 9
(A) Femoral fixation. Good contact with the graft can be checked under direct vision. (B) Tibial fixation with interference screw.

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