title: Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Autograft With Preserved Insertions.
abstract: We present a technique for anterior cruciate ligament (ACL) reconstruction using hamstring tendon autograft with preserved tibial insertions. The tendons, harvested with an open-ended tendon stripper while their tibial insertions are preserved, are looped around to prepare a quadrupled graft. The femoral tunnel is drilled independently through a transportal technique, whereas the tibial tunnel is drilled in a standard manner. The length of the quadrupled graft and loop of the RetroButton is adjusted so that it matches the calculated length of both tunnels and the intra-articular part of the proposed ACL graft. After the RetroButton is flipped, the graft is manually tensioned with maximal stretch on the free end, which is then sutured to the other end with preserved insertions. We propose that preserving the insertions is more biological and may provide better proprioception. The technique eliminates the need for a tibial-side fixation device, thus reducing the cost of surgery. Furthermore, tibial-side fixation of the free graft is the weakest link in the overall stiffness of the reconstructed ACL, and this technique circumvents this problem. Postoperative mechanical stability and functional outcome with this technique need to be explored and compared with those of ACL reconstruction using free hamstring autograft.
authors.affiliation: Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India.
authors.forename: Ravi
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Baba Farid University of Health Sciences, Punjab, India.
authors.forename: Raj
authors.initials: R
authors.lastname: Bahadur
authors.affiliation: Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India.
authors.forename: Anubhav
authors.initials: A
authors.lastname: Malhotra
authors.affiliation: Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India.
authors.forename: Gladson David
authors.initials: GD
authors.lastname: Masih
authors.affiliation: Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India.
authors.forename: Parmanand
authors.initials: P
authors.lastname: Gupta