Her alignment, tibial slope and cartilage were all normal. Femoral press-fit fixation versus interference screw fixation in anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft: 20-year follow-up. - graft that tightens (pulls up into the tibial tunnel) with flexion will have a much higher likelyhood offailure and usually indicates a We NEVER sell or give your information to anyone. Primary ACL reconstruction is recognized as a successful procedure, but failure has been shown to occur in approximately 10% of patients.
Bone Grafting tibial and femoral tunnels knee, failed ACL Bone Incorporation of Silicate-Substituted Calcium Phosphate in 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Histologic and Radiographic Study. Femoral Tunnel Drilling From the Anteromedial Portal Using the Figure-4 Position in ACL Reconstruction. The initial rehabilitation emphasis is focused on restoring tibiofemoral and patellofemoral passive range of motion, restoring quadriceps activation, and controlling and resolving any joint effusion. a statistical evaluation. There has been a long-standing debate as to whether an autograft or an allograft should be used for revision ACLR. The important stages in assessing a patient with failed ACL surgery include history, patient selection, physical examination and investigations, choice of graft, surgical technique, and rehabilitation [7]. Background: Ligament reconstruction is a common procedure in orthopedic surgery. Arthrosc Tech. doi: 10.1016/j.eats.2020.08.024. 2018 Apr-Jun;9(2):116-120. doi: 10.1016/j.jcot.2018.02.010. - Surgical Technique: [21] evaluated 88 patients who underwent one-stage revision ACLR. Arthrosc Tech. Hello, our physician bone grafted the previous ACL tunnels with allograft via arthroscopy. -main criticism is that in some cases a transtibial tunnel will not allow for the exact desiredtunnel placement (you get what you get)
Arthroscopic Delivery of Injectable Bone Graft for Staged Revision The metaphyseal location and predominantly cancellous bone surrounding the graft tissue result in high osteoinductive and osteogenic potential from the hosts bone marrow [26]. Am J Sports Med 34:553564, MARS Group, Wright RW, Huston LJ, Spindler KP, Dunn WR, Haas AK et al (2010) Descriptive epidemiology of the Multicenter ACL Revision Study (MARS) cohort. - lateral tunnel placement: statement and This content does not have an English version. Sci Rep (2016) Griffith TB, et al. -notchplasty
PDF Two-stage revision anterior cruciate ligament reconstruction Arch Orthop Trauma Surg 132:12991313, Thomas NP, Kankate R, Wandless F, Pandit H (2005) Revision anterior cruciate ligament reconstruction using a 2-stage technique with bone grafting of the tibial tunnel.
JCM | Free Full-Text | Femoral Tunnel Position Affects Postoperative i came across this in cpt a revision acl reconstruction and i came anterior, price 8 900 cpt code 29888 anterior cruciate ligament reconstruction acl reconstruction is a surgical tissue graft replacement of the anterior cruciate ligament located in the knee to restore its function after anterior cruciate ligament injury the torn ligament is volume31, Articlenumber:10 (2019) Title: Slide 1 Author: Charles H Brown Created Date: 12/3/2018 11:52:05 AM . The optimal and earliest possible timing of the two-stage procedure is still not clear. Knee stability and graft function after anterior cruciate ligament reconstruction: a comparison of a lateral and an anatomical femoral tunnel placement. Uchida et al. Comparison of Femoral Tunnel Position and Clinical Results. Ki-Cheor Bae. Arthroscopic Revision of Attenuated Anterior Cruciate Ligament Graft With Enlarged Bone Tunnels Using Injectable Bone Graft Substitute. eCollection 2020 Dec. Prall WC, Kusmenkov T, Schmidt B, Frmetz J, Haasters F, Naendrup JH, Bcker W, Shafizadeh S, Mayr HO, Pfeiffer TR. -increased risk of critically short tunnels (<25 mm) and posterior tunnel wall blowout when a conventional offset guide is used Unauthorized use of these marks is strictly prohibited. Terms and Conditions, Effects of femoral tunnel placement on knee laxity and forces in an anterior cruciate ligament graft. The site is secure.
Keywords: Clipboard, Search History, and several other advanced features are temporarily unavailable. Manage cookies/Do not sell my data we use in the preference centre. I would look at billing 29877 for the debridement of the soft tissue. Resurfacing technique consisting of transplantation of multiple osteochondral grafts to smooth the area. Bone and Joint Clinic. Modified Transtibial Versus Anteromedial Portal Technique in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction.
ACL Reconstruction - BTB Graft - Knee & Sports - Orthobullets PMC - Native Anterior Cruciate Ligament Obliquity Versus Anterior Cruciate Ligament Graft Obliquity. - posterior placement or distal to normal site of attachment results in excessive tightening of the graft when knee is extended; Anterior cruciate ligament reconstruction (ACL reconstruction) is a surgical tissue graft replacement of the anterior cruciate ligament, located in the knee, to restore its function after anterior cruciate ligament injury.The torn ligament is removed from the knee before the graft is inserted through a hole created by a single hole punch. No consensus is available regarding the optimal choice of bone graft material for bone tunnel augmentation in revision anterior cruciate ligament (ACL) surgery. After 6 to 12weeks, failures tend to occur in mid-substance [11]. eCollection 2022 Jun. Would you like email updates of new search results? Bone tunnel-related issues are frequently encountered during revision anterior cruciate ligament reconstruction. Unauthorized use of these marks is strictly prohibited. With the rising number of anterior cruciate ligament (ACL) reconstructions, revision ACL reconstructions are becoming increasingly common. Battaglia and Miller [12] indicated that bone grafting should be performed in cases with a tunnel diameter of 1015mm. I am still awaiting the OP note from the ASC, which takes weeks, so I can't post it. <>
The second stage of the revision ACLR was performed a minimum of 3 months later, after obtaining a CT demonstrating adequate filling of the tunnels using a hamstring autograft though a transtibial drilling technique. Background: Anterior cruciate ligament (ACL) reconstruction (ACLR) using bone-tendon-bone (BTB) autograft is associated with increased postoperative anterior knee pain and pain with kneeling and has the risk of intra- and postoperative patellar fracture. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Blurring of the tunnel margins, reactive sclerosis, and the presence of bone within the tunnel were used as signs of adequate healing. TECHNIQUE STEPS. and transmitted securely. They explained that because a bone tunnel of 15mm diameter with 45 of inclination resulted in a tibial tunnel aperture of >20mm, a 20-mm tunnel aperture was regarded as a candidate for grafting. Wheeless' Textbook of Orthopaedics. Epub 2016 Dec 30.
Morphological Changes in the Tibial Tunnel After ACL Reconstruction Would you like email updates of new search results? Although there are many proposed theories for tunnel lysis, it is most accurate to state that this condition has a multifactorial origin; mechanical and biologic causes have been reported, and both contribute to enlarged graft tunnels [11, 13]. This will allow the desired placement of the new tunnels without the risk of loss of structural integrity. If any of those ligaments were missed in the initial knee surgery, they can be treated in the revision setting. 2020 Dec 21;9(12):e1917-e1925. Orthopaedic Specialists of North Carolina. Femoral tunnel placement in single-bundle anterior cruciate ligament reconstruction: a cadaveric study relating transtibial lateralized femoral tunnel position to the anteromedial and posterolateral bundle femoral origins of the anterior cruciate ligament. Drilling the Femoral Tunnel During ACL Reconstruction: Transtibial Versus Anteromedial Portal Techniques. Although several popular techniques are currently in use, new methods are proposed for secure fixation of the tendon graft into the bone tunnel. - resulting anterior-posterior cruciate ligament impingement near extension caused a persistentfunctional extension deficit of 20; Because of weak bone from bone-grafted tunnels or enlarged tunnels, the surgeons should pay careful attention to the fixation methods and consider double fixation in all revisions [37]. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Achieving the correct position can be tricky. Unless the surgeon looks specifically for a ramp lesion at the time of ACL surgery, the lesion can be missed. However, methods used to sterilize allograft material (e.g., gamma irradiation and autoclaving), are known to adversely affect the structural and other properties of the graft material [25]. PubMed, EMBASE, and the Cochrane Library were queried through use of the terms anterior cruciate ligament and revision to identify all studies reporting outcomes of bone tunnel grafting in 2-stage revision ACL reconstruction. 1 0 obj
They observed that an average Accessibility Purpose: To compare the outcomes of different bone graft materials for staged revision ACL reconstruction. - figure four flexedpositionassist with providing the best femoral target; He founded Orthopaedic Specialists of North Carolina in 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital. Data extracted included indications for 2-stage surgery, surgical technique, graft material, time between surgeries, rehabilitation protocols, physical examination findings, patient-reported outcomes, and radiographic and histologic findings. The primary outcome in 2 studies was graft incorporation (mean follow-up, 8.8 months), whereas the other 5 studies reported clinical outcomes with follow-up mean SD of 4.2 2.1 years. - ACL position is lower and more horizontal than that achieved when performing the transtibial (TT) procedure. In the immediate postoperative period, the weakest part of any ACLR is the fixation.
Bethesda, MD 20894, Web Policies Epub 2018 Feb 23. - tunnel positioning: Few studies report the outcomes of two-stage revision ACLR alone. Would this qualify for CPT 29888 with a 52 mod? 5 0 obj
We routinely obtain hip-to-ankle AP X-rays to assess for any coronal plane malalignment. proprioceptive reflex leading to a functional extension loss while the patient is awake. The https:// ensures that you are connecting to the 3. - Effects of notchplasty and femoral tunnel position on excursion patterns of an anterior cruciate ligament graft. Samuelsen BT, Webster KE, Johnson NR, Hewett TE, Krych AJ. What code(s) would be reported for the open removal of retained deep hardware, along with placement of bone graft to the femur and tibial tunnels? ACL graft can replicate the normal ligament's tension curve. Clin Radiol 68:e552e559, Marchant MH Jr, Willimon SC, Vinson E, Pietrobon R, Garrett WE, Higgins LD (2010) Comparison of plain radiography, computed tomography, and magnetic resonance imaging in the evaluation of bone tunnel widening after anterior cruciate ligament reconstruction. A Retrospective Comparative Study However, an absolute threshold for how much tunnel-widening and bone loss is acceptable to undergo a single stage with an intraoperative bone graft prior to drilling has not been established [4, 16,17,18,19]. To compare the outcomes of different bone graft materials for staged revision ACL reconstruction. As this number has continued to increase, the incidence of revision ACL reconstruction (ACLR) has also grown to a rate of between 4.1 and 13.3% of all primary ACLRs performed [2]. Rehabilitation after the initial bone-grafting stage shares similarities with standard ACLR protocols [17]. Arthrosc Tech. 8 Therefore, one should avoid angles <40 to 45 . J Knee Surg 17:127132, Mayr R, Rosenberger R, Agraharam D, Smekal V, El Attal R (2012) Revision anterior cruciate ligament reconstruction: an update. Accessibility [43] reported the results of 54 patients who underwent bone grafting due to recurrent, symptomatic ACL deficiency following ACLR. - over the top position: MeSH (D-F) Coronal and axial computed tomography images showing bone tunnel dilatation (femoral, 15.7 mm; tibial, 9.8 mm). Femoral and Tibial Tunnel Bone Grafting for Stage 1 Revision ACL Reconstruction 10,878 views Apr 25, 2017 NewYorkOrtho 25K subscribers Notice. A decision that will often depend on the graft used during the primary ACLR. Not applicable, this is a review article. J Bone Joint Surg Am 76:10191031, Richter DL, Werner BC, Miller MD (2017) Surgical pearls in revision anterior cruciate ligament surgery: when must I stage? Aust N Z J Surg 69:517521, Eagan MJ, McAllister DR (2009) Biology of allograft incorporation. Improved muscle strength may be the decisive factor; however, changes in functional movement patterns after intensive physical therapy are also important to consider [41]. et al. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 960 540] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
Clinically, many authors have reported good results for two-staged revision ACLR using autograft bone [4, 11]. and transmitted securely. Autograft bone, either from the iliac crest or anterior tibial plateau, is still considered the gold standard source for grafting because of its osteoconductive, osteoinductive, and osteogenic properties. Am J Sports Med 45:20682076, Erickson BJ, Cvetanovich G, Waliullah K, Khair M, Smith P, Bach B Jr et al (2016) Two-stage revision anterior cruciate ligament reconstruction. - Anatomic femoral tunnel drilling in anterior cruciate ligament reconstruction: use of an accessory medial portal versus traditional transtibial drilling However, the results of the postoperative side-to-side differences of the Lachman test as well as the pivot-shift test were significantly superior in group A (<12mm). Anterior cruciate ligament (ACL) reconstruction rates have increased over the past 20years to roughly 200,000 per year [1]. Spine J 7:475490, Jenis LG, Banco RJ (2010) Efficacy of silicate-substituted calcium phosphate ceramic in posterolateral instrumented lumbar fusion. Thomas et al. Lee et al. Tunnel orientation and size are the most important causes related to the two-stage procedure, as these enlarged tunnels may complicate graft placement and fixation [11, 12]. Some authors suggest that an accelerated rehabilitation program for revision ACLR is not appropriate because of weaker initial graft fixation [20]. FOIA
Two-stage revision anterior cruciate ligament reconstruction The indications for staged ACL reconstruction and the rehabilitation protocol between stages need to be clearly established. Unable to load your collection due to an error, Unable to load your delegates due to an error. Root tears also put tremendous forces on the ACL graft and can lead to rotational instability and graft failure. Two-stage revision anterior cruciate ligament reconstruction: a systematic review of bone graft options for tunnel augmentation. Comparison of Femoral Tunnel Position and Clinical Results. - Knee stability and graft function after anterior cruciate ligament reconstruction: a comparison of a lateral and an anatomical femoral tunnel placement. Mayo Clinic has vast experience treating posterior cruciate ligament, lateral collateral ligament, posterolateral and posteromedial corner injuries, as well as medial collateral ligament injuries. Orthop Clin North Am. %PDF-1.5
The results from this group were compared to the results of a matched group of patients with primary ACLR. Eur Spine J 22(Suppl 2):S185S194, von Recum J, Schwaab J, Guehring T, Grutzner PA, Schnetzke M (2017) Bone incorporation of silicate-substituted calcium phosphate in 2-stage revision anterior cruciate ligament reconstruction: a histologic and radiographic study. Revision ACLR surgeries can be mainly divided into one-stage and two-stage procedures.
ACL Reconstruction with a Bone-Patellar Tendon-Bone (BPTB) Graft They are benign ganglion cysts that develop in or around the osseous tibial tunnel made during ACL reconstruction using the transtibial technique 1-2.
Biomechanical Comparison Between Bashti Bone Plug Technique and By using this website, you agree to our A patient with a left knee anterior cruciate ligament tear, torn lateral meniscus and retained hardware from a previous anterior cruciate ligament reconstruction presented for a left knee arthroscopic anterior cruciate ligament repair, open removal of retained hardware and bone grafting of the distal femur and tibial tunnels.Following the arthroscopic anterior cruciate ligament repair, a tibial incision was made through subcutaneous tissue to access the tibial tunnel in order to remove the deep hardware. Allograft bone grafting femoral an Tibial Tunnels, with Debridement of Tunnels The previous ACL graft was debrided with the use of a shaver. Allografts may be well suited for recreational athletes older than 30years of age, but autografts may be a better choice for younger athletes who wish to return to higher-level athletics [4]. Ligaments are strong bands of tissue that attach one bone to . Before View all the articles associated with any code, right from the code page. Am J Sports Med 43:121127, Carson EW, Anisko EM, Restrepo C, Panariello RA, O'Brien SJ, Warren RF (2004) Revision anterior cruciate ligament reconstruction: etiology of failures and clinical results. This adds a fair amount of complexity to the procedure. Bruce A. A Meta-analysis of 47,613 Patients.
$.' anterior cruciate ligament; bone graft; knee; revision. Cancellous allogenic and autologous bone grafting ensure comparable tunnel filling results in two-staged revision ACL surgery. No, I'm sorry that was my bad, you did say allograft, I just overlooked it. Google Scholar, Mitchell JJ, Chahla J, Dean CS, Cinque M, Matheny LM, LaPrade RF (2017) Outcomes after 1-stage versus 2-stage revision anterior cruciate ligament reconstruction. - makesure that interference screws are less than 25 mm in length; For the aforementioned reasons, in this review, we will provide an overview of two-stage revision ACLR in the following order: preoperative planning, surgical considerations, rehabilitation, outcomes, and conclusions. - A Comparison of 2 Drilling Techniques on the Femoral Tunnel for Anterior Cruciate Ligament Reconstruction All authors have made substantial contributions to all of the following: (1): the conception and design of the study, (2) drafting the article or revising it critically for important intellectual content, and (3) final approval of the version to be submitted. A two-stage procedure is technically more demanding than the primary or one-stage procedure and outcomes are potentially inferior, especially for active patients who make a high demand on their bodies. 4 0 obj
For assessment of bone-graft incorporation, radiographs are routinely used. That would help me to provide some better guidance. registered for member area and forum access. Study design: Systematic review. Tunnel malpositioning that will interfere with new revision reconstruction tunnel placement can reduce graft apposition within the tunnels at the time of graft fixation, thereby placing the graft stability and subsequent incorporation at greater risk of failure [11]. eCollection 2021 Oct-Dec. von Recum J, Schwaab J, Guehring T, Grtzner PA, Schnetzke M. Arthroscopy. 2002 Richard O'Connor Award paper. Previous literature has reported that if the tunnel size exceeds 1015mm, two-stage surgery should be performed. Inferior tendon graft to bone tunnel healing at the tibia compared to that at the femur after anterior cruciate ligament reconstruction. We thank Eun-Ji Jeon and Min-Ji Kim for their support. Purpose: Two-stage revision anterior cruciate ligament reconstruction. [11] noted that this suggestion is unnecessary, as using a two-stage technique ensures that there is good-quality bone around the tunnels, and the initial graft fixation is as secure as in the primary reconstruction. eCollection 2021 Oct-Dec. Prall WC, Kusmenkov T, Frmetz J, Haasters F, Mayr HO, Bcker W, Grote S. Injury. eCollection 2022 Mar. They noted that although additional lateral tenodesis did not influence the International Knee Documentation Committee (IKDC) score in a multicenter study of 163 revision ACLRs, the proportion of negative pivot shifts was 80% with lateral tenodesis plus revision ACLR versus 63% without tenodesis. TECHNIQUE STEPS. - w/a right knee, place the tunnel at about the 9:30 to 10 oclock position; A common belief of having 20mm of grafts within the femoral tunnel is backed mostly by hearsay rather than scientific proof. Graft healing within the bone tunnel after anterior cruciate ligament (ACL) reconstruction is still a complex, poorly understood biological process that is influenced by multiple surgical and postoperative variables. Two-stage revision ACLR typically involves an initial bone-graft procedureto fill the widened or misplaced tunnelsand subsequent time to allow for the bone graft to heal sufficiently before the second stage is undertaken [ 5 ]. 2020;38:1191. To me it really is a separate issue especially since the debridement was performed first, not as a clean up after the hardware was removed. MeSH Am J Sports Med 47:324333, Chmielewski TL, Hurd WJ, Rudolph KS, Axe MJ, Snyder-Mackler L (2005) Perturbation training improves knee kinematics and reduces muscle co-contraction after complete unilateral anterior cruciate ligament rupture. A revision procedure may be performed to improved knee function, correct instability, and facilitate a return to normal activities. I wanted to see the history here to better define the stages of reconstruction and see the indication for the procedure being performed in this stage. A Retrospective Comparative Study. For an allograft, a single bone dowel approximately 1mm larger than the diameter of the tunnel is used and placed using a bone tamp for a press-fit technique, ensuring that the entire tunnel is filled [4]. Measurements are made perpendicular to the axial plane of the tunnel at the widest point. 2022 May 11;11(6):e971-e976. Lateral tibial posterior slope is increased in patients with early graft failure after anterior cruciate ligament reconstruction.
Diermeier et al. Arthroscopy 21:767, Wilson TC, Kantaras A, Atay A, Johnson DL (2004) Tunnel enlargement after anterior cruciate ligament surgery. At Mayo Clinic, we frequently perform osteotomies to correct both sagittal plane and coronal plane deformity. You are using an out of date browser. Google Scholar, Group M, Ding DY, Zhang AL, Allen CR, Anderson AF, Cooper DE et al (2017) Subsequent surgery after revision anterior cruciate ligament reconstruction: rates and risk factors from a multicenter cohort. An official website of the United States government. This provides a cylindrical graft, which is delivered to the femoral tunnel through the arthroscopic portal. The same is repeated for the tibial tunnel while providing support for the proximal end of the tunnel. American Journal of Sports Medicine. Mosaicplasty. - Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o'clock and 10 o'clock femoral tunnel placement. - Editorial: The Lateral Intercondylar RidgeA Key to Anatomic Anterior Cruciate Ligament Reconstruction 2017 Apr;33(4):819-827. doi: 10.1016/j.arthro.2016.10.007. This is the great debate in ortho coding. doi: 10.1016/j.eats.2022.03.024. Study design: This content does not have an Arabic version. [40] reported the results of 87 patients who underwent revision ACLR with a follow-up of more than 3 years. It may not display this or other websites correctly. CT analysis also included the determination of the filling rates of the tunnels. 2022 Jun 21;11(7):e1367-e1372.
Revision ACL surgery: A comprehensive approach - Mayo Clinic Overview. CT examinations were performed at 3, 12, and 24weeks after bone grafting. One-Stage ACL Revision Using a Bone Allograft Plug for a Semianatomic Tibial Tunnel That Is Too Anterior. An active infection should be treated with irrigation and debridement with confirmation of eradication (e.g., normalized laboratory test results, negative cultures) before a patient has a new graft and implant put in place. Unfortunately, both previous reconstructions were performed with allograft (cadaver) tissue, which has been shown to have significantly higher failure rates in young patients compared with autograft (the patient's own tissue). Clin Sports Med 36:173187, Trojani C, Beaufils P, Burdin G, Bussiere C, Chassaing V, Djian P et al (2012) Revision ACL reconstruction: influence of a lateral tenodesis. At Mayo Clinic, we sometimes correct the alignment before performing revision ACL surgery, to prevent graft failure. HHS Vulnerability Disclosure, Help The purpose of this article is to review the preoperative planning, surgical considerations, rehabilitation, and outcomes of two-stage revision ACL reconstructions and summarize the recent literature outlining treatment results. Two-stage revision anterior cruciate ligament reconstruction, https://doi.org/10.1186/s43019-019-0010-6, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. PubMedGoogle Scholar. A two-stage revision involves an initial bone grafting procedure to fill the tunnels, followed at least . Knee Surg Sports Traumatol Arthrosc 24:5157, Chahla J, Dean CS, Cram TR, Civitarese D, OBrien L, Moulton SG et al (2016) Two-stage revision anterior cruciate ligament reconstruction: bone grafting technique using an allograft bone matrix. Epub 2020 Apr 1. I forgot to mention he did an allograft bone graft. Recently, a technique for sterilizing musculoskeletal allografts using supercritical carbon dioxide (sCO2) has been developed [26]. <>
The new ligament was fixed to the tibia by a metallic screw and to the femur by a bioabsorbable screw. If this is your first visit, be sure to check out the. endobj
The bone grafting is an opportune time to do an osteotomy to correct the malalignment. Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. The mean time between the two stages was 8.8months and in the second stage, bone-biopsy specimens were taken from the tibia. Cancel anytime. Evaluations were performed in the axial plane of the tibia using three parameters (occupying ratio, union ratio, and bone mineral density). This study aims to identify potential factors for both femoral and tibial tunnel widening (TW) and to investigate the effect of TW on postoperative outcomes after anterior cruciate ligament (ACL) reconstruction with a tibialis anterior allograft. Additionally, Brown and Carson [20] regarded patients with a bone tunnel of <15mm diameter as good candidates for grafting. The bone grafting is an opportune time to do an osteotomy to correct the malalignment. When aperture fixation is not possible, familiarity with, and use of, all-inside tibial and femoral sockets with cortical suspensory fixation may be necessary [4]. -allows the femoral attachment point to overlap the anterolateral and posteromedial bundles insertion site If this is your first visit, be sure to check out the. Data Trace Publishing Company
Given our prior assumption of the STC being 45 mm, the graft-50 rule suggests a 45-mm tibial tunnel if using 25-mm bone plugs. - ref: Modified Transtibial Versus Anteromedial Portal Technique in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction.