title: The use of intraoperative fluoroscopy to reduce femoral interference screw divergence during endoscopic anterior cruciate ligament reconstruction.
abstract: Femoral interference screw divergence can potentially have detrimental consequences in the rehabilitation of anterior cruciate ligament (ACL) reconstruction. Several biomechanical studies suggest that divergence angles greater than 15 degrees significantly decrease the pullout strength of the graft. Numerous techniques have been described in the literature that address this issue; however, the use of an image intensifier intraoperatively is not frequently discussed. We describe a technique in which fluoroscopy is used to confirm the proper position of the femoral interference screw at the time of the procedure, and therefore minimizes the incidence of significant screw divergence. Radiographic analysis of 62 patients who underwent endoscopic ACL reconstruction using bone-patellar tendon-bone autograft using this technique revealed significant divergence in only 3% of patients.
authors.affiliation: Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA. drodin@sbcglobal.net
authors.forename: Dennis
authors.initials: D
authors.lastname: Rodin
authors.forename: I Martin
authors.initials: IM
authors.lastname: Levy
mesh_terms: D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D000886:Anthropometry; D001182:Arthroscopy; D001696:Biomechanical Phenomena; D001863:Bone Screws; D016025:Bone Transplantation; D004868:Equipment Failure; D005269:Femur / Q000000981:diagnostic imaging* / Q000601:surgery; D005471:Fluoroscopy; D006801:Humans; D007430:Intraoperative Care; D007718:Knee Injuries / Q000534:rehabilitation; D010027:Osteotomy; D011183:Postoperative Complications / Q000517:prevention & control; D015641:Radiography, Interventional; D016059:Range of Motion, Articular; D013710:Tendons / Q000637:transplantation