Femoral fixation of hamstring tendon autografts using the TransFix device with additional bone grafting in an anteromedial portal technique.
BACKGROUND
The femoral fixation of hamstring tendon grafts by a cross-pin is an established method with excellent biomechanical properties. Until now, this surgical procedure was associated with a transtibial placement of the femoral tunnel and a graft-tunnel diameter mismatch due to the different volumes of the tendon loop and the tendon strands.


METHODS
By use of an electrical knee positioning device, the transfixation technique can be performed safely through the anteromedial arthroscopic portal (transarticular technique), reaching the optimal lateral '10:30' position in the intercondylar notch. By use of a specific harvesting and implantation device, a cancellous bone plug is harvested and inserted into the femoral tunnel, thus stabilizing the tendon bundle and eliminating dead space in the tunnel.


CONCLUSIONS
The femoral cross-pin guarantees a secure anchorage of the graft, drilling through the anteromedial portal eases optimum tunnel placement, and the insertion of a solid cancellous bone plug eliminates the femoral graft-tunnel diameter discrepancy and improves the press-fit contact between graft and tunnel wall. The long-term benefit of this technical modification remains to be proven.
Galla
Mellany
M
Department for Trauma and Reconstructive Surgery, Henriettenstiftung, Marienstrasse 72-90, 30171 Hannover, Germany. unfallchirurgie@henriettenstiftung.de
Uffmann
Jens
J
Lobenhoffer
Philipp
P
D020341:Absorbable Implants; D016118:Anterior Cruciate Ligament / Q000601:surgery; D001182:Arthroscopy; D001858:Bone Nails; D016025:Bone Transplantation / Q000379:methods*; D004582:Electronics, Medical; D005269:Femur / Q000601:surgery*; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D013709:Tendon Transfer / Q000295:instrumentation* / Q000379:methods; D014182:Transplantation, Autologous