Modified Transtibial Technique for Anterior Cruciate Ligament Reconstruction with Quadriceps Tendon Autograft.

Abstract

The modified transtibial technique with quadriceps tendon autograft allows anatomic anterior cruciate ligament (ACL) reconstruction without tunnel widening and results in a stable and functional knee with a satisfactory clinical outcome. Prepare the patient under spinal anesthesia with the usual arthroscopic setting. Perform arthroscopic examination to confirm the ACL rupture and other intra-articular lesions. <i>Harvest the central one-third of the quadriceps tendon strip with a proximal patellar bone block</i>. Prepare the quadriceps tendon graft to pass smoothly through the tunnels. Make a 3-cm longitudinal skin incision at the anteromedial aspect of the proximal part of the tibia. Drill a 10-mm tibial tunnel. Aim the guide at the lateral bifurcate ridge on the medial wall of the lateral femoral condyle with the modified transtibial technique. Drill a 10-mm femoral tunnel. Fix the graft with adequate tension. Rehabilitate the patient step by step. In a study that compared fifty-two patients managed with a modified transtibial technique and another fifty-two patients managed with an anteromedial transportal technique, there were no significant differences in the clinical results in terms of manual laxity, arthrometric analysis, and subjective outcome.IndicationsContraindicationsPitfalls & Challenges.