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Ebrahimzadeh M.H. MD Department of Orthopedic surgery, Ghaem Hospital Mashhad University of Medical Sciences, Mashhad, Iran. Current Concept in Arthrocopic ACL Reconstruction. Frequency. It is currently one of the most common orthopedic procedures in the world

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Ebrahimzadeh M.H. MD

Department of Orthopedic surgery, Ghaem Hospital

Mashhad University of Medical Sciences, Mashhad, Iran

Current Concept in Arthrocopic ACL Reconstruction

frequency
Frequency
  • It is currently one of the most common orthopedic procedures in the world
  • 6th frequent orthopedic surgery in US
  • 100000 ACL tears each year
  • 75 000 annually primary ACL reconstruction, 3000-1000 revision
the most frequent orthopedic procedure in us
The most frequent Orthopedic procedure in US
  • 1. Knee arthroscopy and meniscectomy
  • 2. Shoulder arthroscopy and decompression
  • 3. Carpal tunnel release
  • 4. Knee arthroscopy and chondroplasty
  • 5. Removal of support implant
  • 6. Knee arthroscopy and anterior cruciate ligament reconstruction
who is candidate for acl reconstruction
Who is candidate for ACL reconstruction ?
  • Knee instability& pain
  • Young ; athlete
  • No or a little DJD
graft choices1
Graft Choices
  • Autografts
    • Bone-patellar tendon-bone
    • Quadrupled hamstrings (Grac & Semi-T)
    • Quadriceps tendon
bptb versus hamestring tendon
BPTB versus Hamestring tendon
  • Liden et al. Am J Spot Med, 2007; 35
  • a prospective, randomized study with a 7-Year follow-up. 34/ 37 pt
  • ----No Significant differences in Lysholm score and IKDC score; patient`s function
bptb versus hamestring tendon1
BPTB versus Hamestring tendon
  • Pinczewski et al. AM Jsport Med. 2007; 37
  • 90 BTBG with 90 ST.Gracilis 10 years Follow-up
  • No difference in function; Lysholm score, IKDC
  • More morbidity in donor site in BTBG
  • More Petellofemoral DJD in BTBG
graft choices2
Graft Choices
  • Allograft
    • Bone-patellar tendon-bone
    • Achilles’ tendon
    • Hamstrings
    • Quadriceps tendon
    • Fascia lata
autograft vs allograft
Autograft vs. Allograft
  • Viral disease transmission (1:1million)
    • Deep freezing leaves some cells (10%)
    • Freeze-drying & cryo weaken graft; limited self-life
  • Graft incorporation & remodeling is faster with autografts. (graft is weakest @ 8-12wks)
  • Donor site morbidity with autografts
interfnce screw
Interfnce screw
  • Biodegradable
  • Metalic
bio vs metal screw
Bio vs Metal Screw
  • Laxdal G. et al. BioVs Metalic Screw
  • Am J Sports Medicine 2006
  • 77pts in a prospective randomised study;
  • 6-24 months,,,, the same function outcome
  • -larger drill hole in bio group
transfix pin screw
Transfix pin/screw
  • Rose et al. :J of Knee Surg, Sport Traumatolo. 2006
  • Prospective randomized study of Transfix vs Bio screw for hamstring reconstruction
  • -38 patients with Transfix versus 30 Bio screw with 12 months follow-up
  • No significant difference in outcome
endobotton femoral fixation
Endobotton Femoral Fixation
  • Promodos and Joyce. J Tech Orthopedics, 2005
  • Endobutton for hamesting femoral fixation of ACL recomstruction, technique and results
  • --139 patients with 2-8 years follow-up
  • -86% reported normal knee stability
anatomic versus non anatomic reconstruction
Anatomic versus non-anatomic reconstruction
  • Anteromedial(vertical) AP stability
  • Posterolateral(Oblique) Rotational Stability
two bundles vs one bundle
Two bundles VS one Bundle
  • Disadvantage of 2 Bundles:
  • Numbers of femoral tunnels
  • Operative time
  • Femoral condyle osteonecrosis, chondrolysis
  • More technically demanding
two bundles vs one bundle1
Two bundles VS one Bundle

JarvelaTimo ; J Knee Surg Sports Tramatol Arthoscpy, 2007, 15

Prospective randomized study with #14 months follow-up

35 pts two bundle 30 pts one bundle

--Lysholm Score and IKDC

--Rotatinal stability (Pivot shif) better in 2 bundle group

present recommendation for 2 bundles
Present recommendation for 2 bundles
  • Only for hands of the most experince ACL surgeon
  • Standard for patients who perfoms demanding pivoting sports
skeletal immature acl reconstruction
Skeletal Immature ACL Reconstruction
  • 6.7% of all ACL tears
  • Physial sparing reconstuction
  • --nonisometric ACL reconstruction
  • Parker Am J Sport Med 1994
partial transphysial acl reconstruction
Partial transphysial ACL reconstruction
  • --Lo Ik et al. Athroscopy 1997
  • --No angular deformity
  • --No LLD
tranepiphysial acl reconstruction
Tranepiphysial ACL reconstruction
  • Guzzanti et al. Am J Sport Med 2003
  • 8 patients with 70 moths of follow-up
  • Average Knee score 97/100
  • 1.8 mm translation difference
  • No growth problem
transphysial acl reconstruction
Transphysial ACL Reconstruction
  • Aichroch PM , Patel D. JBJS Br 2002
  • 47 patients with hamestring ACL reonstruction ,,,
  • 3year follow-up
  • No LLD and no angular deformity
recommendations for adolecent acl reconstruction
Recommendationsfor adolecent ACL reconstruction
  • For delaying surgery patients should restrict sports
  • 1-Hamestring is more deserible
  • Acute and subacute period you can do the sugery