A Technique of Improved Medial Meniscus Visualization by Anterior Cruciate Ligament Graft Placement in Chronic Anterior Cruciate Deficient Knees Christopher.

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A Technique of Improved Medial Meniscus Visualization by Anterior Cruciate Ligament Graft Placement in Chronic Anterior Cruciate Deficient Knees Christopher J. Vertullo, M.B.B.S., F.R.A.C.S., F.A.OrthoA., Lahann Wijenayake, M.B.B.S., Jane E. Grayson, Ph.D. Arthroscopy Techniques Volume 5, Issue 2, Pages e297-e302 (April 2016) DOI: 10.1016/j.eats.2016.01.001 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 Setup 1: Two foot bolsters and lateral thigh support are shown supporting the knee at 90°. This is the optimum position for tibial tunnel drilling. Arthroscopy Techniques 2016 5, e297-e302DOI: (10.1016/j.eats.2016.01.001) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 Setup 2: Foot bolsters and lateral thigh support are shown supporting the knee at 135°. This is the optimal position for transportal femoral tunnel drilling. Arthroscopy Techniques 2016 5, e297-e302DOI: (10.1016/j.eats.2016.01.001) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 Step 1: The bucket handle medial meniscal tear is reduced but not repaired. If not a locked bucket handle tear, the medial meniscus is inspected but not repaired. This is a left displaced medial meniscal tear viewed from the anterolateral portal with the arthroscope at 3 o'clock. The probe is inserted via the anteromedial portal. Arthroscopy Techniques 2016 5, e297-e302DOI: (10.1016/j.eats.2016.01.001) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 Step 2: A systematic joint inspection is undertaken and lateral meniscal repair is performed in the “figure 4” position as required. Arthroscopy Techniques 2016 5, e297-e302DOI: (10.1016/j.eats.2016.01.001) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 Step 3: The femoral tunnel position is selected and drilled. (ACL, anterior cruciate ligament; ACLR, anterior cruciate ligament reconstruction.) Arthroscopy Techniques 2016 5, e297-e302DOI: (10.1016/j.eats.2016.01.001) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 6 Step 4: The gracilis and semitendinosus tendons are harvested, and each tendon end is sutured together using a “baseball stitch.” Arthroscopy Techniques 2016 5, e297-e302DOI: (10.1016/j.eats.2016.01.001) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 7 Step 5: The Endobutton CL is slid over the graft and each end doubled. Arthroscopy Techniques 2016 5, e297-e302DOI: (10.1016/j.eats.2016.01.001) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 8 Step 6: The anterior cruciate ligament graft is drawn into the knee and the femoral side is fixed to the femur by flipping the Endobutton sutures. Arthroscopy Techniques 2016 5, e297-e302DOI: (10.1016/j.eats.2016.01.001) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 9 Step 7: The anterior cruciate ligament (ACL) reconstruction graft is then manually tensioned by the surgeon, using enough tension to prevent anterior tibiofemoral subluxation. Arthroscopy Techniques 2016 5, e297-e302DOI: (10.1016/j.eats.2016.01.001) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 10 Step 8: The reduced medial meniscus is repaired using Fast Fix Ultra devices. Any other method of meniscal repair can be undertaken instead such as inside-out sutures. Arthroscopy Techniques 2016 5, e297-e302DOI: (10.1016/j.eats.2016.01.001) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 11 Step 9: The anterior cruciate ligament graft tibial fixation is undertaken using an interference screw inserted with the knee in extension. Arthroscopy Techniques 2016 5, e297-e302DOI: (10.1016/j.eats.2016.01.001) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions