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Anatomic, Transepiphyseal Anterior Cruciate Ligament Reconstruction by Kyle E. Hammond, John W. Xerogeanes, and Dane C. Todd JBJS Essent Surg Tech Volume.

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Presentation on theme: "Anatomic, Transepiphyseal Anterior Cruciate Ligament Reconstruction by Kyle E. Hammond, John W. Xerogeanes, and Dane C. Todd JBJS Essent Surg Tech Volume."— Presentation transcript:

1 Anatomic, Transepiphyseal Anterior Cruciate Ligament Reconstruction by Kyle E. Hammond, John W. Xerogeanes, and Dane C. Todd JBJS Essent Surg Tech Volume 3(1):e3 January 9, 2013 ©2013 by The Journal of Bone and Joint Surgery, Inc.

2 Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

3 Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

4 Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

5 Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

6 Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

7 Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

8 Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

9 Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

10 Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

11 Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

12 Preoperative markings are made to delineate the fibular head, lateral epicondyle, popliteal insertion, axis of the femoral shaft, and a line perpendicular to the axis from the lateral epicondyle. Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

13 Illustration of the three described portals used with this technique. Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

14 An awl has been utilized to mark the central portion of the femoral footprint, which we utilize for a single-bundle anatomic reconstruction. Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

15 Photograph depicting the extra-articular placement of the FlipCutter at a point between the popliteal tendon’s insertion and the lateral epicondyle. Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

16 The intra-articular (arthroscopic) placement of the FlipCutter’s guide. Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

17 A single fluoroscopic view is obtained to ensure that the FlipCutter pin is placed in the correct, epiphyseal position prior to proceeding with the FlipCutter drill. Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

18 The FlipCutter drill has entered the knee joint at the predetermined femoral footprint. Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

19 When the femoral tunnel is drilled correctly there will be no evidence of the femoral physis or any signs of femoral tunnel blow-out. Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

20 The tibial footprint in addition to the posterior portion of the anterior horn of the lateral meniscus are both used to place the tibial tunnel guidepin in the central portion of the tibial footprint for a single-bundle ACL reconstruction. Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

21 Postoperative anteroposterior radiograph showing that, with our described technique, the femoral tunnel is transepiphyseal. Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

22 Postoperative lateral radiograph. Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

23 Preoperative 3D MRI template, lateral view. Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

24 Preoperative 3D MRI template, posterior view. Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

25 Comparison of this lateral, sagittal CT image with the preoperative 3D MRI template shows a well-placed femoral tunnel that is transepiphyseal and does not encroach onto the femoral physis. Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

26 This intercondylar, sagittal CT image depicts accurate recreation of the femoral tunnel anatomy. Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

27 Posterior, coronal CT image. Kyle E. Hammond et al. JBJS Essent Surg Tech 2013;3:e3 ©2013 by The Journal of Bone and Joint Surgery, Inc.

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