Download ACL Made Simple - D. Johnson (Springer, 2004) WW PDF

TitleACL Made Simple - D. Johnson (Springer, 2004) WW
TagsMedical
LanguageEnglish
File Size8.3 MB
Total Pages219
Table of Contents
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Document Text Contents
Page 2

Springer
New York
Berlin
Heidelberg
Hong Kong
London
Milan
Paris
Tokyo

Page 109

Figure 6.48. The use of a burr to open up the stenotic notch.

Figure 6.49. The use of the curette to perform a soft tissue notchplasty.

103

Page 110

104 6. Hamstring Graft Reconstruction Techniques

Figure 6.50. The completed notchplasty.

fat behind the PCL so the drop-off can be clearly seen. Figure 6.50
shows the fringe at the back of the notch, which the physician must see
to determine the over-the-top position for the guide. A 6-mm oval burr
should be used to remove the bone. This does not jump around as much
as the round burr. Linvatec makes a southpaw for left knees that also
eliminates the jumping. The author makes a small divot with the burr
at the position that the tunnel should be, that is, 7mm in from the drop-
off at 11 or 1 o’clock. The major mistake would be not to clear enough
soft tissue to expose the posterior aspect of the notch. This can result in
drilling the tibial tunnel too anterior. The result is late failure of the
graft.

Tibial Tunnel

Choosing the correct position for the tibial tunnel is crucial to the rest
of the operation. The landmarks are external surface of the tibia, 4cm
from joint line, 2cm medial to tibial tubercle; inside, 7mm anterior to
the leading edge of the PCL, in the midline.

The Linvatec tibial guide is set at 55° (Fig. 6.51). The guide is inserted
through the anteromedial portal, by turning it upside down. The knee

Page 218

212 Index

Tibia (cont.):
plateau fracture of the, 17
rotation of, stress on the anterior

cruciate ligament, 6
screw pullout strengths from, 56
subluxing forward, protection

against, 6–7
tunnels through, in prepubescent

patients, 37
Tibial fixation

in patellar tendon grafting, 134–137
of soft tissue, 61

Tibial osteotomy, with reconstruction,
in osteoarthritis and anterior
cruciate ligament injury, 39

Ti-Cron sutures, 98–100, 111
Timing of operation, controversial,

188
Tomograms, in diagnosis of anterior

cruciate ligament injury, 22
Toradol, for a femoral nerve block, 67
Tourniquet, in hamstring graft

reconstruction, 68
Treatment options

for anterior cruciate ligament
injuries, 31–44

for partial tears of the anterior
cruciate ligament, 29–30

Trocar, for reducing the handle of a
meniscus tear, 90

Tunnel
dilation of, to improve pullout

strength of the interference
screw, 109

femoral
complications of, 164–167
drilling of, 105–108
graft introduced into, 111
guide wire passed up anterior

aspect of, 133
marking a graft for introducing

into, 100
for a patellar tendon graft,

130–133
placing a screw in, 172
surgical technique for, 182–183
X-ray assisted placement of, 191

malposition of, as a complication of
reconstruction, 162–166

mapping and drilling, 4
mismatch with a graft, 173
placement of, 190

in anterior cruciate ligament
reconstruction, 61–62

causing recurrent instability, 179
in grafting operation, 46
and range of motion, 52

radiographic morphology of,
evaluating Bioscrew osteolytic
effects, 187

securing soft tissue to, in
reconstruction, 55–56

tibial
anterior malposition of, 162–163
drilling in harvesting of the

hamstring graft, 91
graft introduction into, 111
in the immature athlete, 155
for a patellar tendon graft, 124,

128–130
positioning, 104–106
screw size and, 172
surgical technique for, 182–183

Tunnel expansion
after anterior cruciate ligament

reconstruction, 180
on follow-up, hamstring graft with

Bioscrew fixation study, 183
Tunnel notching, to start the Bioscrew,

in hamstring grafting, 109–110
Two-fist sign, 12–13
Tylenol, 119

V
Valgus

knee rotated with, 6
stress of

avoiding after surgery, 153
in the pivot-shift test, 14

stress testing of, 18–20
Valgus position, of female athletes on

landing from a jump, 8
Varus

force applied to knee in meniscal
repair, 78–80

stress of, avoiding after surgery,
152

stress testing of, 18–20

Page 219

Index 213

Vascular access channels, creating in
meniscus repair, 75

Vioxx, 119
for patellar tendon grafting, 122

Viscoelasticity, of ligaments in the
knee, 4

Visualization, of the screw angle, to
prevent damaging a graft, 171

W
Wedge osteotomy, for osteoarthritis

with anterior cruciate ligament
deficiency, 39

W-maneuver, to view an entire joint,
23–24, 69–71

X
X-ray

evaluation of anterior cruciate
ligament reconstruction, 33

femoral tunnel placement assisted
by, 191

for identifying laxity causes, 179

Z
Zimmer splint, to aid ambulation after

surgery, initial period, 139–140
Zone-specific repair, of a

bucket-handle tear of the
meniscus, 81–83

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