Combined Anterior Cruciate Ligament Primary Repair With an Autograft Reconstruction

Anterior cruciate ligament (ACL) reconstruction using an autograft gives good results that could provide improved failure rates. ACL augmentation saving the remnant has demonstrated advantages, such as saving vascular supply and nerve receptors, which could be useful for healing. Conversely, isolated repair techniques are gaining interest but do not give good results because structural augmentation is necessary to reinforce the repair and expect healing. We describe a technique combining the advantages of both techniques with an autograft using the semitendinosus and repair of the remnant. This combined technique allows protection and redirection of the remnant, improves graft incorporation, and covers more graft by suturing the remnant around an autologous graft

Patellar Tendon Reconstruction Using Hamstring Tendon and Adjustable Suspensory Cortical Fixation

Chronic patellar tendon rupture is a rare injury; extensor mechanism impairment leads to great disability in daily life. The delayed diagnosis and reconstruction of chronic patellar tendon ruptures are technically challenging. Numerous surgical procedures have been described with bone-tendon-bone graft, hamstring graft, artificial ligament, and allograft. We describe safe, reproducible anatomic reconstruction of the patellar tendon using hamstring tendon and adjustable suspensory fixation. After harvesting of the hamstrings, the graft is prepared with 2 adjustable suspensory fixation devices. Then, a complete tibial tunnel and a patellar tunnel with a socket are drilled with the appropriate diameter, and the graft is pulled through the tunnels. Finally, the suspensory fixation devices on the tibial and patellar sides are tensioned. The aim of this procedure is to obtain complete mobility of the knee, using a procedure similar to anterior cruciate ligament reconstruction in graft preparation

Suspensory Fixation Device for Use With Bone–Patellar Tendon–Bone Grafts

Good to excellent results at long-term follow-up have been published for bone–patellar tendon–bone (BTB) graft anterior cruciate ligament reconstruction. Fixation using screws historically has been the most common choice for femoral and tibial bone blocks, but screws present several disadvantages, which include the risk of blowout (for which prevention implies having to shift the position of the tunnel anteriorly), as well as lesions of the bone blocks and tendons. This article describes a technique using Pullup BTB adjustable–loop length suspensory fixation (SBM, Lourdes, France) on the femoral and tibial sides. The graft is harvested and prepared classically. This device combines the advantages of suspensory fixation (precise position of the tunnel, high tensile strength), with the advantages of the adjustable loop (control of bone block position within the femoral tunnel, possibility of retightening the graft) and allows for double passage of the loop through each bone block for increased safety. So, it could represent an interesting and secure option for anatomic reconstruction of the anterior cruciate ligament when a BTB graft is chosen