Indications
Revision
Multi-ligament injury
Older patient
Technique
Graft preparation
Calcaneal bone plug for femoral tunnel
Prepare bone plug
- decide on bone graft size needed
- 12 mm wide if revision / 10 mm if primary
- 20 mm long
- 10 mm deep
Cut with microsagittal saw
- take central third
- trim to size
- ensure passes nicely through cylinder
- no sharp edges
- drill holes as per normal bone block, 2 x 1 ethibond sutures
Tendon
- 12 mm wide in man
- 10 mm in woman
Keep tendon long
- no need to cut short
- can cut at end of case
- the tendon will remain outside of knee
- fixate this end with Kochers
- no sutures required
Tunnels
Drill tunnels as per standard technique
- beath pin in femur
- drill desired depth to 5 mm more than bone graft length
- eg 25 for 20
- line to line diameter
Fixation
Pass graft
Femoral fixation
- fix with 9 x 25 mm screw if 12 mm tunnel / graft
- otherwise 7 x 25 mm tunnel if 10 mm tunnel / graft
Tension graft
Tibial fixation
- 9 x 35 mm screw
- augment with staple