ACL Reconstruction with Bone Patellar Tendon Bone Autograft - Technique
Drapping and Set Up
- Lateral post
- Foot rest
- Contralateral leg sling
Exam under anesthesia
- Midline incision from mid-patella to tibial tubercle
- Create sub-Q flaps
- Incise peritenon and expose to edges of patella tendon and place Kelly under patella tendon.
- Retract with army-navy and sins
- Harvest middle 1cm of patella tendon mark c ruller and cut superior to patella and 2.5-3 cm into patella. Cut down to tibial tubercle and 2.5-3cm into tibial tubercle.
- Use 1cm saw blader and cut tibial tubercle 1 cm deep c rhomboid cut and remove with use of 0.5 cm straight osteotome.
- Remove infrapatella tendon fat up to patella.
- Use 1cm saw blade and cut straight down on patella about 0.5-1 cm. Use 0.5 cm blade and cut underneath patella to release graft.
- Remember to expose medial side of tibia for graft portal placement.
Prepare Patella graft
- Squench graft to fit through tunnel about 10mm and remove non-collagen debri.
- Drill one hole on patella side of graft and place ethabond suture and hemostat. Cut off needle.
- Drill two holes on tibial tubercle side of graft and place two ethibonds and clip with hemostats.
- Mark with blue pen transition b/t bone and tendon on patellar side.
- Create standard inferior lateral and medial portals through skin.
- Diagnostic scope and pictures.
- Perform notch plasty.
- Set tibial tunnel finder at set degree (40-45 degrees)
- Place tibial tunnel guide through medial arthroscopy portal. Tip should line up with anterior horn of the lateral meniscus and 7 mm anterior to PCL.
- Starting point on tibia should be 1-2 cm medial to tibial tubercle.
- Use beef pin and make pilot drill, watch with scope.
- Drill tunnel with drill or acorn bit to appropriate size.
- Clean tunnel with rasp or
- Flex knee to greater than 90 degrees.
- Use over the top guide to leave 2mm of posterior wall of femoral tunnel, and place at 11 o'clock (R knee) or 1 c'clock (L knee).
- Use beef pin through over the top guide and out through skin.
- Drill femoral tunnel to 30 mm. Clean tunnel.
- Pull graft through tunnel and stop when blue mark reaches femoral bone tunnel.
- Make notch anterior for screw pin.
- Place screw pin into notch and tap for appiture fixation
- Place femoral tunnel screw.
- Pull tension on distal aspect of graft and range the knee.
- Place tibial screw pin, tap and place tibial appiture fixation.
- Trim tip of graft if needed.
- Close peritenon
- Close skin