[Implant-free replacement of the anterior cruciate ligament with the double bundle technique: a modification of Pässler's operation technique].

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Abstract

[Indexed for MEDLINE] 14. Oper Orthop Traumatol. 2019 Feb;31(1):20-35. doi: 10.1007/s00064-018-0580-6. Epub 2018 Dec 18. [Combined posterior and anterior cruciate ligament reconstruction : Arthroscopic treatment with the GraftLink® system]. [Article in German] Ateschrang A(1), Ahrend MD(2), Ahmad S(2), Körner D(2), Stein T(3), Yesil M(4), Stöckle U(2), Schreiner AJ(2). Author information: (1)Sektion Sporttraumatologie und arthroskopische Chirurgie, BG Unfallklinik Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Deutschland. aateschrang@bgu-tuebingen.de. (2)Sektion Sporttraumatologie und arthroskopische Chirurgie, BG Unfallklinik Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Deutschland. (3)BG Unfallklinik, Frankfurt, Deutschland. (4)Ahmet Necdet Sezer Hospital, Afyonkarahisar, Türkei. OBJECTIVE: Simultaneous arthroscopic reconstruction of the anterior and/or posterior cruciate ligament (ACL/PCL) using the GraftLink® system (Arthrex) to obtain stable treatment and good functional results. The transplant is protected by the safety belt like biomechanical GraftLink® principle, which is used to secure the intraoperatively obtained stability in the long term. INDICATIONS: ACL, PCL, or combined cruciate ligament rupture, especially multiligament injuries. Revision ACL and PCL reconstruction. CONTRAINDICATIONS: Preoperative fixed posterior tibial subluxation. Reduced range of motion (ROM) with an extension lag (extension/flexion 0‑0-120° preoperatively required). Complex regional pain syndrome. High-grade atrophy of the quadriceps femoris muscle and osseous deformities. SURGICAL TECHNIQUE: Supine position with mobile leg and possible flexion of at least 120° allowing antegrade femoral bone tunnel replacement. Retrograde tunnel placement (e. g. using a retrocutter) is recommended in case of less than 120° knee flexion. Thigh tourniquet. Staging arthroscopy. Cruciate ligament reconstruction is realized by anatomic tunnel placement for the ACL/PCL using the GraftLink®. Recommended sequence of reconstruction: 1. tibial PCL tunnel, 2. femoral ACL tunnel, 3. femoral PCL tunnel, 4. tibial ACL tunnel. Hybrid fixation is recommended. Portals: High anteromedial, high anterolateral, posteromedial, posterolateral, small subvastus incision. POSTOPERATIVE MANAGEMENT: Combined cruciate ligament replacement: Gradual load and ROM increase in the PCL track. After postoperative week 5, increasing load up to full weight bearing, with extension/flexion 0‑0-90° after week 7. Down training of the PCL track after week 13. Contact and competitive sports after 1 year. RESULTS: The GraftLink® system allows restoration of knee joint stability with good functional results. The procedure is especially suitable for complex situations like after knee dislocation with ACL and PCL reconstruction in 1 or 2 steps. DOI: 10.1007/s00064-018-0580-6