MacIntosh Procedure

Technique

 

Incision

- lateral border femur

- 15 cm proximal to knee joint

- curve anteriorly across patella tendon

 

Harvest ITB

- expose ITB

- width and length depend on patient size

- usually central 3 cm

- take 25 - 30 cm in length

- tubularise end and leave threads long to pass tendon

 

Lateral dissection

- expose and elevate LCL

- 2cm subperiosteal tunnel above and posterior to this

- pass tendon deep to LCL and through subperiosteal tunnel

- pass inferiorly through intermuscular septum

 

Posterolateral incision

- anterior to lateral head of gastrocnemius

- allows tendon to be passed around femoral condyle

 

Medial parapatella incision

- open joint

- make drill hole from anteromedial tibia to posterior to tibial spine

- this prevents anterior impingement

- make appropriate width for tendon

- do so under direct vision

 

Pass graft

- pass curved instrument through knee and out lateral incision

- retrieve graft into knee

- retrieve through tibial tunnel

- tension

- suture graft at LCL

- pass graft under patella tendon and suture to origin