Specialized Toolkit Series: ACL Reconstruction-All-Inside Quadrupled Semi-T ACLR

Video Transcription

The following is a surgical demonstration for an all-in-side ACL reconstruction done with a quadruple semi-tenosus autograft.  In this particular patient, the graft diameter was 9mm and this is the left knee. You can see a classic mid-substance ACL tear here.  The femoral socket is created first outside in, drilled immediately. The guide is brought through the lateral portal, positioned at the anatomic attachment for the ACL.  The guide pin is drilled outside in, opened up to 9mm to match the graft diameter. The femoral socket is retrocut to a depth to accommodate at least 20mm of graft ultimately  in the femoral socket. The shaver is used to remove all debris. The pin is brought back, unflipped and removed. Then a shuttle suture passed.  You can see the excellent position of this femoral socket. On the tibial side, a small medial incision is made for replacement of the guide sleeve.  The same pin is drilled into the joint, an optimal position evident with the old ACL fibers as well as the anterior attachment of the lateral meniscus.  It's opened up to 9mm to retrocut the tibial socket again to accommodate at least 20mm of graft into the socket here. I make it a bit longer to allow for graft tensioning.  The pin is brought back in the joint, unflipped and removed and a shuttle suture passed through the tibia.  Then a femoral shuttle suture is used to pull the graft across with the suspension fixation button pulled across the femur and flipped for fixation here and then the shortening  strands of the suspension device on the femur are used to hoist the graft again to a depth of 20mm up into the femur as seen here.  The next step is for passage of graft into the tibia with the shuttle suture that was placed here.  Now on the tibial side, a button is applied to the suspension fixation device and is brought into full extension and then the shortening strands here on the tibia are used to secure  the graft. These handles help prevent cuts on the fingers, give very secure fixation and retention on  both sides and then this is the final construct, actual position of the graft across the femur and tibia. A notch blast is not routinely done.  You can see bringing it into full hyperextension, there is no impingement on this graft.

Video Summary

The video demonstrates an all-inside ACL reconstruction using a 9mm quadruple semitendinosus autograft on a left knee. It begins with creating the femoral socket using an outside-in drilling approach, followed by the tibial socket creation. Both sockets are drilled to accommodate 20mm of the graft. A shuttle suture is used for graft passage, and suspension fixation devices secure the graft in both the femur and tibia. The final construct shows the graft positioned across the femur and tibia with no impingement during full hyperextension.

Asset Caption

Patrick Smith, M.D.
Columbia Orthopaedic Group
Columbia, Missouri

Keywords

ACL reconstruction

quadruple semi-tendinosis autograft

femoral and tibial sockets

suspension fixation buttons

hyperextension

semitendinosus autograft

femoral socket

tibial socket

suspension fixation