ACL-Restoration with Semitendinosus Tendon

All-Inside Technique and
Bioabsorbable Interference Screws

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Introduction

The most common method of surgically reconstructing an insufficient anterior cruciate ligament involves using an autologous tendon graft. The most often used graft for this procedure is the middle third of the patient's own ipsilateral patellar tendon. Because there is always some degree of donor-site morbidity associated with harvest of the middle third patellar tendon, there has recently been a trend to use the hamstring tendons. Traditionally the hamstring tendons are fixed extracortically away from the joint. On the tibial side a complete bone tunnel is performed.

Short description of the method

In the here described operating technique the triple stranded semitendinosus tendon is fixed directly at the original attachment site of the ACL using bioabsorbable interference screws. Both interference screws are inserted endoscopically (inside-out). The free part of the semitendinosus tendon is not longer than the intraarticular distance. Thus the elastic deformation of the graft is reduced. The procedure is performed minimally invasive and endoscopically. The femoral and tibial socket is approached through the joint. This technique avoids the creation of an open tibial tunnel which is often a cause for significant pain and discomfort in the early postoperative period. Thus the postoperative rehabilitation is further simplified.

Advantages of this method

This operative technique considers the results of all important clinical and experimental studies about ACL surgery of the last years (Dye O.). The use of the semitendinosus tendon reduces donor site morbidity. Both femoral and tibial sockets are formed with minimally invasive technique at the joint surface. The triple stranded semitendinosus tendon is stronger than a bone patellar tendon bone autograft. Both femoral and tibial bioabsorbable interference screws are inserted endoscopically "inside-out". The graft is fixated close to the joint near the anatomical ACL attachment sites which reduces the free length of the graft as well as its elasticity. The optimal physio-anatomical position and the good primary fixation strength of the graft permit rapid postoperative rehabilitation. No permanent metallic implants are used and therefore eventual future MRIs or new operations not compromised (Stahelin A.C.).

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Please send questions or remarks to: kruzlifix@staehelin.ch

Copyright 1996 Andreas C. Staehelin
Most recent revision 4 August 1996