Download ppt - Revision Anterior Cruciate Ligament Reconstruction with Doubled Semitendinosus and Gracilis Tendons and Lateral Extra-Articular Reconstruction by Andrea

Revision Anterior Cruciate Ligament Reconstruction with Doubled Semitendinosus and Gracilis Tendons and Lateral

Extra-Articular Reconstruction

by Andrea Ferretti, Fabio Conteduca, Edoardo Monaco, Angelo De Carli, and Carmelo D'Arrigo

J Bone Joint Surg AmVolume 89(2 suppl 2):196-213

September 1, 2007

©2007 by The Journal of Bone and Joint Surgery, Inc.

Preoperative lateral (left) and anteroposterior (right) radiographs showing a failed anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft.

Andrea Ferretti et al. J Bone Joint Surg Am 2007;89:196-213


T1-weighted magnetic resonance image of a failed anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft.



Extensive bone loss due to convergence of tibial tunnels is managed with Evolgate fixation and grafting: A: bone loss; B: the Evolgate device (Citieffe, Bologna, Italy); C: preparation for

Evolgate insertion; and D: Evolgate inserted with tendon passage.



Failure of anterior cruciate ligament reconstruction due to an anteriorly placed femoral tunnel.







Positioning of the patient on the operating table.



Location of the central transtendinous arthroscopic portal.



Intra-articular view of a failed anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft due to graft elongation.



Removal of an interference screw with an arthroscopic grasper.



Localization of atibial fixation device with the aid of fluoroscopy.



Semitendinosus tendon stripping.



Lateral hockey-stick incision.



The iliotibial tract is incised along its fibers (A), after which the vastus lateralis is retracted, exposing the lateral femoral condyle (B).



Tendons mounted on the workstation.



Reamings from the drill are collected and used for grafting.







The Evolgate device is composed of three titanium-alloy components: a coil (a spiral 21 mm in length and 10 mm in diameter) with a spike positioned at one extremity, a 9 × 20-mm screw, and

a washer.



A, B, and C: Insertion of the coil of the Evolgate (Citieffe) in the bone tunnel.



The Swing-Bridge (Citieffe) device consists of a titanium-alloy cylinder (diameter, 10 mm) with a smooth metal half-ring (diameter, 10 mm) at one end and a shelf with grooves at the other.



Final fixation with screw and washer.











