Engaging needles: a simple technique for arthroscopic side-to-side rotator cuff repair.
We propose that the tibial remnant of the anterior cruciate ligament (ACL) is able to enhance the revascularization and cellular proliferation of the graft, to preserve proprioceptive function, and to acquire anatomic placement of the graft without roof impingement. Therefore, it seems reasonable to assume that preserving the tibial remnant as much as possible as a source of reinnervation, if technically possible without causing impingement, would be of potential benefit to the patient. Our surgical technique was developed to maximize the preservation of the tibial remnant. The distally attached semitendinosus and gracilis tendons are harvested using a tendon stripper. Once satisfactory placement of 2 guide pins convergently is done, create a closed-end socket in the lateral femoral condyle with an adequate sized curved curette. For anatomic placement of the graft, the tibial tunnel should be positioned within the boundaries of the normal ACL tibial remnant. The reamer must be advanced very carefully to minimize injury to the residual remnant at the intra-articular margin of the tibial tunnel. Penetration should stop at the base of the stump. The folded grafts are then pulled intra-articularly through the tibial tunnel, the tibial remnant, and the femoral socket by pulling sutures under arthroscopic visualization. The ACL tibial remnant is compacted by the tendon passage. The graft is secured proximally by tying sutures in the lateral femoral condyle and distally at the tibia with double staples using a belt-buckle method. The advantages of our technique include maximal preservation of the tibial remnant, no roof impingement from intrasynovial anatomic placement of the graft, the simplicity of the procedure, the minimal need for hardware or special instruments, the economic benefit, and the potential prevention of tibial tunnel enlargement by preventing synovial fluid leakage.
Almazán
Arturo
A
Arthroscopy and Sports Medicine Department, National Rehabilitation Institute, Mexico City, Mexico. docalmazan@hotmail.com
Nieves
Jorge
J
Patiño
Paúl
P
Ruiz
Michell
M
Cruz
Francisco
F
Pérez
Francisco Xavier
FX
Ibarra
Clemente
C
D000768:Anesthesia, General; D001182:Arthroscopy / Q000379:methods*; D006801:Humans; D009339:Needles; D009407:Nerve Block; D017006:Rotator Cuff / Q000601:surgery*; D013536:Suture Techniques / Q000295:instrumentation