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Anatomic anterior cruciate ligament reconstruction: the two-incision technique

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

This article describes the anatomical two-incision reconstruction of anterior cruciate ligament (ACL) of knee. The major part of currently single incision tibial endoscopic techniques attempts to reproduce the most isometric anteromedial bundle of ACL. Often a relatively vertical femoral tunnel, respect to the notch, is drilled, which is not really efficacious in providing rotatory stability. The single incision technique was developed to obviate the necessity of the lateral femoral incision and dissection. This technical note describes a two-incision ACL reconstruction using an instrumentation, which avoids a large lateral femoral soft tissue dissection, and discusses the rational use of the two-incision ACL reconstruction technique.

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References

  1. Acker JH, Drez D (1989) Analysis of isometric placement of grafts in ACL reconstruction procedures. Am J Knee Surg 2:65–70

    Google Scholar 

  2. Amis AA, Jacob RP (1998) Anterior cruciate ligament graft positioning, tensioning and twisting. Knee Surg Sports Traumatol Arthrosc 6(Suppl 1):S2–S12

    Article  PubMed  Google Scholar 

  3. Arnold MP, Kooloos J, van Kampen A (2001) Single-incision technique misses the anatomical femoral anterior cruciate ligament insertion: a cadaver study. Knee Surg Sports Traumatol Arthrosc 9(4):194–199

    PubMed  CAS  Google Scholar 

  4. Bach BR Jr (1989) Arthroscopy assisted patellar tendon substitution for anterior cruciate ligament reconstruction. Am J Knee Surg 2:3–20

    Google Scholar 

  5. Bernard M, Hertel P, Hornung H, Cierpinski T (1997) Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg 10(1):14–21

    PubMed  CAS  Google Scholar 

  6. Buss DD, Warren RF, Wickiewicz TL, Galinat BJ, Panariello R (1993) Arthroscopically assisted reconstruction of the anterior cruciate ligament with use of autogenous patellar-ligament grafts. Results after twenty-four to forty-two months. J Bone Joint Surg Am 75(9):1346–1355

    PubMed  CAS  Google Scholar 

  7. Cain EL Jr, Clancy WG Jr (2002) Anatomic endoscopic anterior cruciate ligament reconstruction with patella tendon autograft. Orthop Clin North Am 33(4):717–725

    Article  PubMed  Google Scholar 

  8. Chambat P, Selva O (1999) Reconstruction du ligament croisè anterieure par autogreffe au tendon rotulien. Forage du tunnel fémoral de dehors en dedans. In: Sociéte Francaise d’Arthroscopie (eds) Elsevier, Paris, pp 144

  9. Cooper DE, Urrea L, Small J (1998) Factors affecting isometry of endoscopic anterior cruciate ligament reconstruction: the effect of guide offset and rotation. Arthroscopy 14(2):164–170

    Article  PubMed  CAS  Google Scholar 

  10. Denti M, Bigoni M, Randelli P, et al (1998) Graft–tunnel mismatch in endoscopic anterior cruciate ligament reconstruction. Intraoperative and cadaver measurement of the intra-articular graft length and the length of the patellar tendon. Knee Surg Sports Traumatol Arthrosc 6(3):165–168

    Article  PubMed  CAS  Google Scholar 

  11. Fanelli GC, Desai BM, Cummings PD, et al. (1994) Divergent alignment of the femoral interference screw in single incision endoscopic reconstruction of the anterior cruciate ligament. Contemp Orthop 28:21–25

    Google Scholar 

  12. Friederich NF, O’Brien WR (1990) Functional anatomy of the cruciate ligaments. In: Jacobs RP, Staubli HU (eds) The knee and the cruciate ligaments. Springer, Berlin Heidelberg New York

    Google Scholar 

  13. Furia JP, Lintner DM, Saiz P, Kohl HW, Noble P (1997) Isometry measurements in the knee with the anterior cruciate ligament intact, sectioned, and reconstructed. Am J Sports Med 25(3):346–352

    Article  PubMed  CAS  Google Scholar 

  14. Getelman MH, Friedman MJ (1999) Revision anterior cruciate ligament reconstruction surgery. J Am Acad Orthop Surg 7(3):189–198

    PubMed  CAS  Google Scholar 

  15. Gill TJ, Steadman JR (2002) Anterior cruciate ligament reconstruction the two-incision technique. Orthop Clin N Am 33:727–735

    Article  Google Scholar 

  16. Girgis FG, Marshall JL, Monajem A (1975) The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop 106:216–231

    Article  PubMed  Google Scholar 

  17. Giron F, Buzzi R, Aglietti P (1999) Femoral tunnel position in anterior cruciate ligament reconstruction using three techniques. A cadaver study. Arthroscopy 15(7):750–756

    Article  PubMed  CAS  Google Scholar 

  18. Good L, Gillquist J (1999) The value of intraoperative isometry measurements in anterior cruciate ligament reconstruction: an in vivo correlation between substitute tension and length change. J Arthrosc Relat Surg 9:525–532

    Article  Google Scholar 

  19. Hefzy MS, Grood ES, Noyes FR (1989) Factors affecting the region of most isometric femoral attachments. Part II: The anterior cruciate ligament. Am J Sports Med 17(2):208–216

    Article  PubMed  CAS  Google Scholar 

  20. Howell SM, Deutsch ML (1999) Comparison of endoscopic and two-incision techniques for reconstructing a torn anterior cruciate ligament using hamstring tendons. Arthroscopy 15(6):594–606

    Article  PubMed  CAS  Google Scholar 

  21. Khalfayan EE, Sharkey PF, Alexander AH, et al. (1996) The relationship between tunnel placement and clinical results after anterior cruciate reconstruction. Am J Sports Med 24:335–341

    Article  PubMed  CAS  Google Scholar 

  22. Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL (2003) Knee stability and graft function following anterior cruciate ligament reconstruction: comparison between 11 o’clock and 10 o’clock femoral tunnel placement. Arthroscopy 19(3):297–304

    Article  PubMed  Google Scholar 

  23. Noyes FR, Butler DL, Grood ES, Zernicke RF, Hefzy MS (1984) Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions. J Bone Joint Surg Am 66(3):344–352

    PubMed  CAS  Google Scholar 

  24. Sapega AA, Moyer RA, Schneck C, et al. (1990) Testing for isometry during reconstruction of the anterior cruciate ligament: anatomical and biomechanical considerations. J Bone Joint Surg Am 72:259–267

    PubMed  CAS  Google Scholar 

  25. Scopp JM, Jasper LE, Belkoff SM, Moorman CT III (2004) The effect of oblique femoral tunnel placement on rotational constraint of the knee reconstructed using patellar tendon autografts. Arthroscopy 20(3):294–299

    Article  PubMed  Google Scholar 

  26. Sgaglione NA, Schwartz RE (1997) Arthroscopically assisted reconstruction of the anterior cruciate ligament: initial clinical experience and minimal 2-year follow-up comparing endoscopic transtibial and two-incision techniques. Arthroscopy 13(2):156–165

    Article  PubMed  CAS  Google Scholar 

  27. Simmons R, Howell SM, Hull ML (2003) Effect of the angle of the femoral and tibial tunnels in the coronal plane and incremental excision of the posterior cruciate ligament on tension of an anterior cruciate ligament graft: an in vitro study. J Bone Joint Surg Am 85(6):1018–1022

    PubMed  Google Scholar 

  28. Webb JM, Corry IS, Clingeleffer AJ, Pinczewski LA (1998) Endoscopic reconstruction for isolated anterior cruciate ligament rupture. J Bone Joint Surg Br 80(2):288–294

    Article  PubMed  CAS  Google Scholar 

  29. Zavras TD, Race A, Bull AM, Amis AA. (2001) A comparative study of ‘isometric’ points for anterior cruciate ligament graft attachment. Knee Surg Sports Traumatol Arthrosc 9(1):28–33

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Hopital Orthopedique, de la Suisse Romande, Avenue Pierre Decker 4, 1005, Lausanne, Switzerland

    Raffaele Garofalo & Olivier Siegrist

  2. Clinique Saint’Anne Lumiere, Lyon, France

    Pierre Chambat

  3. Centre Hospitalier Universitaire Vaudois, OTR-BH 14, CHUV, 1011, Lausanne, Switzerland

    Elyazid Mouhsine

Authors
  1. Raffaele Garofalo
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  2. Elyazid Mouhsine
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  3. Pierre Chambat
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  4. Olivier Siegrist
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Correspondence to Elyazid Mouhsine.

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Garofalo, R., Mouhsine, E., Chambat, P. et al. Anatomic anterior cruciate ligament reconstruction: the two-incision technique. Knee Surg Sports Traumatol Arthr 14, 510–516 (2006). https://doi.org/10.1007/s00167-005-0029-y

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  • DOI: https://doi.org/10.1007/s00167-005-0029-y

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