Anatomic anterior cruciate ligament reconstruction using the over-the-top passage of hamstring tendons

Maurillo Marcacci, Stefano Zaffagnini, Leonardo Marchesini, Marco Delcogliano, Danilo Bruni

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

The anterior cruciate ligament (ACL) reconstruction using a double-bundle gracilis and semitendinosus technique guarantees a more anatomic reconstruction and allows the surgeon to avoid the use of hardware for graft fixation. The tendons are harvested, maintaining their tibial insertion. The tibial tunnel is located in the medioposterior part of the ACL tibial insertion. For the femoral tunnel, the guide pin is advanced from anteromedial portal to 10 o'clock position in the medial wall of the lateral condyle and passes until reach the femoral cortex. The exit point in the lateral aspect of the femur should be immediately above the end of the lateral femoral condyle. The tendons are passed over the top. The correct placement is found by palpating the posterior tubercle of the lateral femoral condyle with a finger. The stitches on the free end of the tendons are tied onto the passing suture that is pulled through the knee joint into the over-the-top position. A suture loop is introduced into the joint through the anteromedial portal using a suture passer and then pulled into the femoral tunnel. The stitches on the free end of the tendons are looped again onto the passing suture, which is pulled through the femoral tunnel, knee joint, and tibial tunnel to retrieve the graft from the tibial incision. The combined gracilis and semitendinosus tendons are then tensioned and secured with a transosseous suture knot. This technique attempts to reproduce the kinematic effect of both anteromedial and posterolateral bundle of the ACL.

Original languageEnglish
Pages (from-to)123-129
Number of pages7
JournalOperative Techniques in Orthopaedics
Volume15
Issue number2
DOIs
Publication statusPublished - Apr 2005

Fingerprint

Anterior Cruciate Ligament Reconstruction
Thigh
Sutures
Tendons
Anterior Cruciate Ligament
Knee Joint
Bone and Bones
Transplants
Biomechanical Phenomena
Femur
Fingers
Hamstring Tendons
Joints

Keywords

  • ACL reconstruction
  • Arthroscopy
  • Double-bundles
  • Hamstrings tendons

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Anatomic anterior cruciate ligament reconstruction using the over-the-top passage of hamstring tendons. / Marcacci, Maurillo; Zaffagnini, Stefano; Marchesini, Leonardo; Delcogliano, Marco; Bruni, Danilo.

In: Operative Techniques in Orthopaedics, Vol. 15, No. 2, 04.2005, p. 123-129.

Research output: Contribution to journalArticle

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