ACL Reconstuction.
Over the past 10 yrs there is a rising no of Cruciate ligament injuries at a ratio of 10:1 ACL/PCL ratio. May be the awareness is increasing in Gods own country or the vaidyans are being left out, Even the Vaidyans are asking for MRI before referring or treating the same. The changes in technique in my practise has been double bundle reconstruction when young,sporty and affordable and single bundle reconstruction with the femoral tunnel being at 10'o'clock to better control rotations. AM on tibia and PL on femur. As far as fixation goes we do endobutton with aperture screw on femur and intrafix on tibia. At one year followup we have not seen any functional difference between the two.
My take on bioscrew at both are 1. On the femoral side i end up damaging part of the graft occasionally and on 2 occasion my entire graft pulled out of the femoral tunnel on tensioning before tibial fixation. This has not happened yet with a suspensory fixation like enobutton or transfix.
ACL:PCL 1:10 i thought ACL injuries were more commoner
ReplyDeleteU r right. I accidently reversed it
ReplyDeletejacob
isnt the whole scenario of double/ single, endobutton/bio/transfix lil too confusing?.. can we as of today say that hamstring single bundle with bio at both ends is the best option
ReplyDeleteAs far as bioscrew is concerned I have had one bony reaction to the screw on the tibial side with pain and had to be curreted and grafted. Damage to the graft and twisting of the graft on the femoral side on occasion and lastly twice i have had the graft pull out from the femoral tunnel while tensioning before tibial fixation. The suspensory Fixation avoids these problems though they have there on problems of windshield Wiper effect and more femoral vertical orientation with a transfix inspite of rotating the over the top guide as it is trans tibial. If we make the tibial entry point more posterior on the tibial metaphysis one could get a 10 o clock femoral tunnel but beware over damaging the superficial mcl.
ReplyDeleteHi
ReplyDeleteTwo reasons why you had the graft rupture before inserting the tibial screw, could be that the screw and tunnel are not colinear during insertion and second may be should always use a screw 2 sizes below on femoral side.
I still dont beleive, lot of your patients for whom you have done double bundle, are level 1 or 2 sportsman for whom rotational stability is important. But somewheresomeone has to start doing it and i am glad you are may be the first in India. Hopefully you will get out some early results and show us all