New Technique of Anterior Cruciate Ligament Reconstruction Using Hamstrings - the Surgical Instrumentation Set
Abstract
PURPOSE OF THE STUDY The success rate of the anterior cruciate ligament (ACL) reconstruction depends on the fixation of the graft, the surgical technique and, of course, on the experience of the operating surgeon. The authors present the development of the construction of the new instrumentation set designed to manage the ACL lesions using the hamstring (HS) tendons.
The study is divided into two parts, of which part one focuses on construction, methods and work with new instruments, while part two presents the outcomes of the surgery. MATERIAL AND METHODS Fixation of hamstring grafts depends, contrary to the union of bone blocks in the Bone-Tendon-Bone (BTB) graft and the bone tunnel, on the method of tendon graft fixation and compression inside the bone tunnel.
The instrumentation set for ACL reconstruction is designed to be used for hamstring tendons (semitendon and gracilis) forming four strands of the prepared graft. The system was designed as the fixation of the graft using the femoral screw with eyelet and a press-fit fixation using a metal interference screw in tibia.
The easiest and fastest option has proven to be the pulling of the screw with eyelet through the tibial tunnel and intra-articular space to the femoral canal, where fixation by screwing in is done. The exact position of the inserted screw is verified by the measuring gauge.
The screw is pulled in by the long version of the femoral screwdriver and Kirschner wire passing through the middle of the screw with eyelet. The advantage of this system consists in the subsequent insertion of the interference screw by the same wire, which guarantees its exact positioning in the centre between the individual strands of the graft (thanks to the specific way of ligament preparation).
The possibility of later tensioning of the graft by tightening the femoral screw is another advantage. DISCUSSION Compared to other methods using the HS tendons, the advantages of the described operative technique consist in the simplicity of the used instrumentation procedure.
The technique of graft fixation inside the femoral canal is not suitable for bioabsorbable materials. It is offset by the fixation stability and the possibility of final graft tensioning.
CONCLUSIONS The newly developed instrumentation set for ACL reconstruction is fit for purpose, easy as to the surgical technique, and it guarantees the logical sequence of surgical steps reducing surgical errors to minimum. The instrumentation set is user-friendly, easy to handle and, once the operating surgeon masters the surgical procedure, it allows to reduce the duration of the surgery to approximately 30 minutes.
There were no major complications or technical errors reported during the surgical procedures using these instrumentation set.