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. 2015 Jan 5;4(1):e1-6.
doi: 10.1016/j.eats.2014.09.007. eCollection 2015 Feb.

Anatomic Double-Bundle Reinsertion After Acute Proximal Anterior Cruciate Ligament Injury Using Knotless PushLock Anchors

Patrick Weninger  1 , Florian Wepner  1 , Florian Kissler  1 , Michael Enenkel  1 , Christian Wurnig  1
Affiliations

Anatomic Double-Bundle Reinsertion After Acute Proximal Anterior Cruciate Ligament Injury Using Knotless PushLock Anchors

Patrick Weninger et al. Arthrosc Tech. .

Abstract

Direct anterior cruciate ligament (ACL) repair has been described with different suture techniques after acute ACL injury, but these procedures showed high failure rates. Recent studies, however, led to a better understanding of the biology of primary ACL healing. This article describes a novel technique combining the "healing response technique" with primary anatomic double-bundle ACL reinsertion after an acute proximal ACL tear using nonabsorbable No. 2 FiberWire (Arthrex, Naples, FL) and PushLock knotless suture anchors (Arthrex). We recommend this technique for patients with acute proximal avulsion-type ACL injuries. Postoperatively, we recommend a knee brace locked in full extension for at least 4 weeks to ensure adequate immobilization and then to increase knee flexion slowly over the next 4 weeks for subsequent healing of the ACL repair. Our technique combines anatomic positioning and reinsertion of the ACL bundles with microfracturing of the region delivering stem cells and growth factors to the repaired ACL, creating optimal conditions for the healing period. In certain cases this technique might be an alternative to conventional ACL reconstruction with autograft or allograft tendons.

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Figures

Fig 1
Fig 1
Acute proximal avulsion–type ACL injury (arrow) with blood clot in footprint (left knee, central-portal view, 90° of knee flexion).
Fig 2
Fig 2
Microfracture awl in femoral footprint (left knee, central-portal view, 90° of knee flexion).
Fig 3
Fig 3
Setting 2 to 3 microfractures in femoral anteromedial footprint (left knee, central-portal view, 90° of knee flexion).
Fig 4
Fig 4
Setting 2 to 3 microfractures in femoral posterolateral footprint (left knee, central-portal view, 120° of knee flexion).
Fig 5
Fig 5
A SutureLasso (black arrow) is passed through the posterolateral bundle (white arrow) (left knee, central-portal view, 90° of knee flexion).
Fig 6
Fig 6
A TigerWire is passed through the posterolateral bundle (left knee, central-portal view, 90° of knee flexion).
Fig 7
Fig 7
A FiberWire is passed through the anteromedial bundle, and both ends are passed through the medial portal with a KingFisher (left knee, central-portal view, 90° of knee flexion).
Fig 8
Fig 8
The free end of the TigerWire is passed through the anteromedial portal with a KingFisher (left knee, central-portal view, 90° of knee flexion).
Fig 9
Fig 9
The FiberWire and TigerWire are both outside the anteromedial portal (left knee, central-portal view, 90° of knee flexion).
Fig 10
Fig 10
The hole for the PushLock anchor for posterolateral bundle reinsertion is drilled in the posterolateral footprint (arrow) (left knee, central-portal view, 120° of knee flexion).
Fig 11
Fig 11
PushLock insertion for posterolateral bundle reinsertion (left knee, central-portal view, 120° of knee flexion).
Fig 12
Fig 12
Inserted PushLock (arrow) and reattached posterolateral bundle (left knee, central-portal view, 120° of knee flexion).
Fig 13
Fig 13
ACL after reinsertion of anteromedial bundle in 90° of knee flexion to femoral anteromedial footprint with additional PushLock anchor (left knee, central-portal view, 90° of knee flexion).
Fig 14
Fig 14
The stability of the reinserted ACL is tested (left knee, central-portal view, 90° of knee flexion).
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References

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