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Femoral Tunnel Drilling in ACL Surgery PDF

50 Pages·2016·3.27 MB·English
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Preview Femoral Tunnel Drilling in ACL Surgery

Jeffrey R. Dugas, MD Birmingham, Al Mark Clatworthy Tim Roberts Middlemore Hospital Auckland New Zealand No disclosures related to the subject matter  of this presentation. Significant changes in the way ACL surgery  is performed  Double Bundle  Various Femoral Tunnel Drilling techniques  Addition of various biologic “enhancements” Basic science supports the fact that the ACL  is comprised of two “bundles” of fibers which function in conert. Idea of recreating two bundles certainly  seems reasonable given the native anatomy Clinically challenging technique to get two  grafts at the native origin of the ACL Clinical results have (to date) failed to show  superiority or reliable equivalence to large scale clinical studies of single bundle ACL reconstruction. Many early adopters of this technique have  returned to single bundle ACL reconstruction. Transtibial drilling was the most common  technique until 5-10 years ago.  Evidence that transtibial drilling led to unacceptable position of the femoral tunnel  Possible cause of early failure of ACL graft due to vertical orientation.  Medial Portal Drilling espoused as the solution to more accurately recreate the normal anatomic origin of the ACL. Miller et al and others 2010-2014   “It is borderline malpractice to drill through the tibial tunnel.”

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May 2009 – May 2013 – Hamstring Transportal ACLR. ◇ Transportal ACLR technique - 30% distal (forward) off the back wall and lower (posterior),.
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