Anterior cruciate ligament reconstruction with autologous quadriceps tendon graft and press fit fixation

Introduction: This article describes an arthroscopic anterior cruciate ligament (ACL) reconstruction technique with a quadriceps tendon autograft using an anteromedial portal technique. Material and methods: A 5 cm long quadriceps tendon graft is harvested together with an adjacent 2 cm bone block. The femoral tunnel is created in its anatomical position through a deep anteromedial portal. The tibial tunnel is created with a hollow burr, thus acquiring a free cylindrical bone block. The graft is then passed through the tibial tunnel and the bone block customized at its tip and tapped into the femoral tunnel through the anteromedial portal to provide press-fit fixation. The graft is tensioned distally and sutures are tied over a bone bridge at the distal end of the tibial tunnel. From the cylindrical bone block harvested from the tibia the proximal end is customized and gently tapped next to the graft tissue into the tibial tunnel to also assure press fitting of the graft in the tibial tunnel. The distal part of the tibial tunnel is filled with the remaining bone. Results and conclusion: This technique presented was shown to be reproducible and to achieve good clinical results at the early follow-up examination. Potential advantages include minimum bone loss specifically on the femoral side and fixation without implants. The use of a quadriceps tendon graft preserves the dynamic function of the hamstring tendons for stabilization of the knee joint against valgus stress. © 2018, Springer Medizin Verlag GmbH, ein Teil von Springer Nature.