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ACL RECONSTRUCTION USING MINIMAL INVASIVE HARVESTED QUADRICEPS TENDON
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Graft Passage
The suture loop from the bone plug or the free
suture ends from the tendon end of the graft
(= end without bone) to the FlippTack® are
now tied off to equal the measured length of the
femoral tunnel. When a bone plug is used, its
distal end should fit flush with the intra-
articular cortex.
Correct graft rotation is an important
consideration during graft passage. It is easier
to achieve correct graft rotation with the knee
slightly extended. Once the plug has been
properly rotated, the knee is flexed and the
graft is pulled completely into the joint. When
it is confirmed that the fixation button has been
flipped, the graft is pulled back through the
tibial tunnel to seat the button securely against
the femoral cortex. Now the knee joint is taken
through 10 cycles of flexion-extension while
traction is maintained on the distal leads. Then,
with the knee flexed approximately 20°, the
tibial end of the graft is fixed with a 7 or 8 x
28 mm absorbable interference screw inserted
on the lateral side of the graft. Additionally, the
sutures are tied over an EndoTack® (Karl
Storz, Germany) (fig. 6a).
Fig. 5:
A tibial dilator of the appropriate size is carefully driven into place.
Fig. 6:
(
a
) Radiographic result and (
b
) Cosmetic
results after ACL reconstruction with a QT graft
and minimally invasive subcutaneous harvesting
technique.
a
b