Presentation on theme: "STIF INTRA ARTICULAR CCL RECONSTRUCTION"— Presentation transcript:
1STIF INTRA ARTICULAR CCL RECONSTRUCTION STIF CCL ligaments are different for Right or Left joint to respect physiological torsion .Recommended Ligaments and Screwskgs : 30 fibres with free intra articular fibres of mm - drill bit diam 3.6 mm X20 screws30-35 kgs : 44 fibres - free fibers 22mmDrill bit diam. 4.2 mm X20 screwsAbove 35kgs 60 fibres - free fibres 28mmDrill bit 5mm X25 mm screwsThe size of the ligament depends also of the size of the notch and the bones . The strongest that can be used is recommended .
2CCL 30-17 R THE FREE INTRA ARTICULAR FIBERS 30 fibers 17mm intra articularRightCCL R
3For soft tissue protection Male screwdriver Female screwdriverTelescopic tubesFor soft tissue protectionMale screwdriver2 blunt K wiresDrill bits5mm -4.2mm- 3.6mm6x wire loops2 K wires2mmX20cmDouble ended shqrpPassing tube 20 cm2 hexagonal K wires
5STEP 1 : femoral guide K wire A medial parapatellar arthrotomy approach offers a better view
6STEP 2:the guide K wire is drilled down into the tibia STEP 2 : the K wire is inserted downwards into the tibia from the femoral side.The flexion is ajusted to allow the penetration of the Kwire at the posterior part of the tibial CCL foot print
7STEP 2b is :another option for the tibial K wire If the orientation of the Kwire in the femur does not allow a proper direct placement in the tibia or leads to a friction of the ligament against the notch , the Kwire can be drilled separately with the joint in hyper flexionThe Kwire is placed into the foot print and drilled down towards the medial tibial cortex
8STEP 3 : drilling of the tunnels Hold the Kwire during the tibial drillingProtection tubeThe telescopic tubes are inserted on the K wire to protect the soft tissues; The cannulated drill bit adapted to the size of the ligament is guided by the K wire . The drillings are performed from outside-in to avoid damages to remnants and cartilage
9STEP 4 :passage of the ligament The Wire passing tube is placed through the tunnels followed by the wire loop . The passing tube is removedThe threads of the ligament are inserted through the loop and the ligament is pulled until the free fibres are adjusted intra articularly
10STEP 5 : femoral fixation Cannulated screwHexagonal K wire1or 2 cm of the hexagonal K wire are inserted into the tunnel parallel to the ligament. Then the appropriate screw is driven down and inserted with the female screw-driver until 1 mm remains outside the cortex . The telescopic tubes can be used if needed .
11STEP 6 : adjustment of tension and tibial fixationThe ligament is tensioned once and then the joint is put in full flexion and extension. If the placement is isometric there should not be any movement in the tibial tunnel . A small sliding of 1or 2 mm is admissible and the tibial fixation must be completed to allow a full range of motion . The ligament must never be over tightThe insertion of the screw is made like on the femoral side with the help of the hexagonal K wire ; The male screw driver is used to adjust the insertion when the K wire has been removed
12Note about fixationThe screws have to be tight in the bony tunnels. If there is a doubt about the strength of the fixation ( bone density –heavy and active dog ) it is recommended to drill a second transverse tunnel .Insert the extremity of the ligament in it and put a second screw
13POST OPERATIVE CARE No immobilisation or brace are necessary Full weight bearingControl the activity of the dog for one month