Knotless Primary Anterior Cruciate Ligament Repair with Adjustable Loop Device and Internal Brace Augmentation

Abstract

With the recent resurgence of primary anterior cruciate ligament repair, it is important to strive for optimal patient outcomes. This knotless primary repair procedure takes advantage of the use of an adjustable loop device, which allows for intraoperative retensioning by the surgeon. This technical advancement combined with augmentation with an internal brace could potentially minimize gap formation at the repair site, thereby increasing repair stability and ultimate outcome.

Fig 1

Arthroscopic view of left knee from anterolateral portal of Sherman 2 type proximal anterior cruciate ligament tear with probe in anteromedial portal.

Fig 2

Arthroscopic view of left knee from anterolateral portal of 0-TigerLink (bottom suture) and 0-FiberLink (top suture) cinch sutures in proximal anterior cruciate ligament fibers.

Fig 3

A) Picture of the 0-FiberLink suture which has short closed loop available after creating cinch suture configuration; B) Picture of the 0-TigerLink suture, which also has a short closed loop available after creating cinch suture configuration.

Fig 4

A) 0-TigerLink and 0-FiberLink cinch sutures in proximal anterior cruciate ligament (ACL) fibers with short loops distal to cinch evident; B) Wire from Banana Lasso passed through distal loops (arrow) of both with 0-TigerLink and 0-FiberLink cinch sutures in proximal ACL fibers; C) FiberLink cinch suture attached to loop of BTB TightRope (step #1 on card) is passed through looped end of wire outside PassPort cannula (arrow 1) to shuttle this loop through the two distal loops of the 0-TigerLink and 0-FiberLink cinch sutures in proximal ACL fibers, and the wire is pulled out PassPort cannula to deliver loop (arrow 2); D) Loop of BTB TightRope now passed through the two distal loops of 0-TigerLink and 0-FiberLink cinch sutures in proximal ACL fibers exiting out PassPort cannula (arrow); E) Free suture end of BTB TightRope (step #2 on card) is now passed through the looped end of the BTB TightRope outside the PassPort cannula (arrow); F) Free suture end of the BTB TightRope is now passed through the small blue loop (step #3 on card) and pulled by the two small free end blue sutures to complete splice so this free end becomes the second shortening strand of the BTB TightRope, thus completing creation of the adjustable loop device.

Fig 5

Arthroscopic view of left knee from anterolateral portal of probe from anteromedial portal showing presence of two distal loops present with 0-TigerLink and 0-FiberLink cinch sutures in proximal ACL fibers.

Fig 6

Picture of BTB TightRope card to create adjustable loop device for primary ACL repair fixation.

Fig 7

Completed left knee knotless primary anterior cruciate ligament repair with adjustable loop device fixation and internal brace viewing from anterolateral portal.