Graft selection for ACL reconstruction

Intraarticular reconstruction
Graft selection
Graft selection
Graft selection
Graft selection
Graft placement

 IntraarticTiming of surgery

After recovery from the initial injury

Resolution of inflammation

Return of full motion

Postop stiffness

ular reconstruction


Technical issues

Graft selection

Graft Placement

Graft Tensioning

Graft Fixation


Graft selection

Autologous hamstring

Triple- or quadruple- stranded 

Strength : semiT 75%, gracilis 49% of ACL


Concern

Tendon healing within the bone tunnel

Lack of rigid bony fixation

RCT 

No significant difference in graft failure between BPTB and hamstring


Graft selection

Donor site morbidity

Potential weakness of knee flexion ?


No significat difference in hamstring torque at 2 years after surgery

Regeneration of tendons

Toshino et al. : significant weakness when flexion > 70’



Graft selection

Allografts

No donor site morbidity

Shorter surgery time

Smaller incisions

Greater availability


Risk of disease transmission


From currently available literature,

Graft source has minimal effect on the outcome

Good results of autograft in young, active patients



Graft placement

Femoral attachment site is more critical

Proximity to center of axis of knee motion

Too anterior

Capturing of the knee

Loss of flexion


Tibial tunnel site

Posterior portion of the ACL tibial insertion

Decrease graft impingement while extension


Limited notchplasty

Narrow intercondyar notch shown to contribute to ACL injury

Excessive notchplasty may move femoral attachment site


Graft placement

Vertical tunnel position

High in the intercondylar notch (12 o’clock position)

Stability in AP plane

But rotatory instability


10 or 2 0’clock position

More anatomic

Provide rotatory stability

Limitation of transtibial technique

Through low medial portal or two-incision technique




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