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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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