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I'm Dr. Eric Johnson from SportsMED in Huntsville alabama i'm performing an
acl double bundle reconstruction
the patient came to me with looseness pain and swelling of his knee after an
injury
here we're going to harvest the tendons first to reconstruct a torn
anterior cruciate ligament doing the double bundle technique
the two tendons that we're harvesting off the tibia here the gracilis and
semitendinosus are released off the tibia
and a loop stitch is placed around each tendon individually
we will then take a tendon stripper place it over the tendon
and push it up towards the muscle freeing it from its muscle belly
here you can see one of the two tendons that has been harvested
on the back table we will individually prepare each tendon
the gracilis to go for the posterior lateral bundle
and the semitendinosus for the anterior medial bundle
next after preparing the tendons we will go ahead and make our arthroscopic portals
two below the patella one for the scope and one for the working portal
and one above the patella
for the inflow of the fluid
once the portals are established and the scope is in the knee
we will then watch the monitor as we go around the knee
from a diagnostic standpoint and also treatment
here we can see the torn anterior cruciate ligament
it's no longer attached onto the femur as it has been torn and no longer
functional
we will begin by removing the ligament
here you can see the shaver as we remove the old ligament
we will then identify both the bundles from the original anterior cruciate ligament
where they attached on the upper bone where the femur and the lower bone the tibia
next we will make a small incision on the inner aspect of the knee where we will come
in just above the medial meniscus
and first place a drill pin
in the anterior medial bundle
portion of the old anterior cruciate ligament
on the femur above here we can see the guide pin going in
with measuring device on it
the shaver will then be used to remove the bone and the soft tissue
from around this drill point
next we'll have a ruler that we place up into the tunnel to measure the length of
the tunnel
and we already know the diameter of the tendon that we will use
therefore using appropriate reamer as seen here to go to the appropriate depth
and also make the right diameter tunnel
next a drill guide is used that is placed in the anterior medial bundle
and a drill point is placed here for the posterior lateral bundle insertion site
we then remove the bony debris
and we've already reamed over the top to make the appropriate sized tunnel
the femor has now been prepared and we turn our attention to the tibial side
the tibial guide will then be placed in
and the guide pin will be placed to the insertion site of the anterior medial bundle
here we can see the pin entering the joint
we will then ream over top of this pin as you can see the reamer coming in here and
once again clean out the bony debris as well as the soft tissue
the guide will then be used from outside the knee as you can see into the tunnel here
and a guide pin will be placed through the other part of the guide
and once again a reamer will be placed over to make the insertion site for the posterior
lateral bundle on the tibia
a guide pin is then placed up each of the two tunnels
with a suture attached that will be pulled out of the knee
as we see the guide pin going in the anterior medial
tunnel here
we then pull it down on the tibial side
through the tunnel and outside the knee where it will be attached to the graft
likewise for the posterior lateral we will do the same thing of placing a suture to
retrieve our tendon
each tendon will then be attached to its individual suture and pulled up into the
Knee
Here we can see the posterior lateral bundle coming in first with an indo button that
that we pull through the tibia and through the femur and locked onto the femur
likewise the anterior medial bundle will be fed in and pulled in through the
knee
as well
once both tendons are locked in on the femoral side we will then secure them with screws
into the tunnel on the tibial side
to make them nice and tight
the excessive graft is removed from outside the knee, we close the small wound where the
graft was harvested and the graft was placed in and
steri strips are placed over that wound a drain is seen on the top of the knee that will remove
any excess blood
the dressing is then applied
the patient will then be placed in a knee immobilizer
for more information on this and other procedures go to w_w_w_ dot sportsmed
alabama dot com