Strand Hamstring Tendon ACL Reconstruction

35 Pages·2017·6.3 MB·English

by  Johnson, Kelly

Hamstring (soft tissue)
ACL Reconstruction
Indications and Surgical Pearls
Aaron Bare, MD
Northwestern Medicine
Director, Shoulder, Knee and Sports Medicine
Northwestern Orthopedic Institute
11th Annual ATC Conference
Winfield, IL
6/17/2017
Case
19 year old competitive female
basketball player with torn ACL
Questions
When ?
How ?
Graft
Technique
Clinical History
70% noncontact
Pivoting injury
Foot planted
Deceleration
Hyperflexion
Hyperextension
30% direct contact
ACL
Epidemiology
ACL Injury Demographics
50,000 -100,000
reconstructions/year in US
Epidemiology
Annual incidence 1 in 3000 per athlete
With approximately 100,000 primary ACL
reconstructions performed annually in the US (over $2
billion of health care dollars
Even a small percentage of non-successfully surgical
results equates to thousands of unhappy athletes
every year
Opportunity for the Athletic Trainer and
Staff
The initial evaluation
Education / Treatment
– Preoperative
– Postoperative
4
Exam - 1st is best
ROM
Lachman
Anterior drawer
Pivot Shift
Varus/Valgus
Dial test
Meniscus stress
Best exam is directly after
the injury (prior to the
effusion)
Championing the ACL
12
1
Graft selection
2
3
Fixation
Technique - tunnel
orientation
Graft Selection
Bone-Patella Tendon-Bone
Autograft (BTB)
Hamstring (ST/G) Autograft
Quadriceps Tendon Autograft
Allografts
• BTB
• Posterior tibialis
• Hamstring
ACL Reconstructive Options
Grafts
– Patella Tendon
– Hamstring Tendon
– Allograft
Technique
Rehabilitation
Patella Tendon Graft Hamstring Graft