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Current Concept in Arthrocopic ACL Reconstruction

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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Current Concept in Arthrocopic ACL Reconstruction

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  1. Ebrahimzadeh M.H. MD Department of Orthopedic surgery, Ghaem Hospital Mashhad University of Medical Sciences, Mashhad, Iran Current Concept in Arthrocopic ACL Reconstruction

  2. 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

  3. 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

  4. Who is candidate for ACL reconstruction ? • Knee instability& pain • Young ; athlete • No or a little DJD

  5. Graft choices

  6. Graft Choices • Autografts • Bone-patellar tendon-bone • Quadrupled hamstrings (Grac & Semi-T) • Quadriceps tendon

  7. Semitendinus&Gracilis

  8. 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

  9. 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

  10. Graft Choices • Allograft • Bone-patellar tendon-bone • Achilles’ tendon • Hamstrings • Quadriceps tendon • Fascia lata

  11. 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

  12. Graft Fixation

  13. Interfnce screw • Biodegradable • Metalic

  14. 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

  15. Intefrance Screw

  16. Transfix

  17. 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

  18. Crosspin/transfix

  19. Endobuttom Loop

  20. 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

  21. Ham. Graft passer for Transfix

  22. One bundle or two bundle ACL reconstruction

  23. Anatomic versus non-anatomic reconstruction • Anteromedial(vertical) AP stability • Posterolateral(Oblique) Rotational Stability

  24. 16 weeks old fetus

  25. Two bundles VS one Bundle • Disadvantage of 2 Bundles: • Numbers of femoral tunnels • Operative time • Femoral condyle osteonecrosis, chondrolysis • More technically demanding

  26. 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

  27. Present recommendation for 2 bundles • Only for hands of the most experince ACL surgeon • Standard for patients who perfoms demanding pivoting sports

  28. Skeletal Immature ACL Reconstruction

  29. Skeletal Immature ACL Reconstruction • 6.7% of all ACL tears • Physial sparing reconstuction • --nonisometric ACL reconstruction • Parker Am J Sport Med 1994

  30. Partial transphysial ACL reconstruction • --Lo Ik et al. Athroscopy 1997 • --No angular deformity • --No LLD

  31. 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

  32. 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

  33. 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

  34. The End

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