Anatomic All-Inside Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon Autograft

Abstract

All-inside anterior cruciate ligament reconstruction has recently gained popularity, in part because of its bone-sparing socket preparation and reported lower pain levels after surgery. However, because this technique uses suture loops and cortical suspension buttons for graft fixation, it has mostly been limited to looped graft constructs (e.g., hamstring autograft, peroneus longus allograft). Quadriceps tendon autograft offers several advantages in anterior cruciate ligament reconstruction but, until recently, has not been compatible with suture-loop and cortical suspensory fixation. We describe a technique that allows a relatively short (<75 mm) quadriceps tendon autograft (without bone block) to be used with established all-inside anatomic techniques.

Figures

Fig 1

(A) Distal end of graft after whipstitching with FiberLoop (in blue). The BTB TightRope will be placed at the X. (B) Assembling BTB TightRope through distal end of graft: FiberLoop sutures (a); free end of TightRope limb passed through suture trap and button by blue passing suture (b); TightRope loop passed through graft with straight needle (c; needle removed, not shown); TightRope tensioning limbs (d); and passing suture (e).

Fig 2

The ABS TightRope (in white) is placed between the superficial and deep layers of the (originally) proximal end of the graft. The path of the FiberLoop (in blue) for the whipstitch is shown.

Fig 3

Final construct of tibial side of graft with ABS TightRope (in white) and FiberLoop (in blue).

Fig 4

Right knee (medial is on right and superior is at top of image, with patella shown as dashed line centrally) before passage of BTB TightRope sutures. The sutures are passed using the FiberStick (in blue). Both the FiberStick and TigerStick have been docked out of the anteromedial portal before any sutures are passed.

Fig 5

Right knee (medial is on right and superior is at top of image, with patella shown as dashed line centrally) before passing free No. 2 FiberWire, secondary tibial graft-passing suture, and ABS TightRope. The order for suture pulling is marked. The TigerStick (dashed lines) is pulled first, docking the free No. 2 FiberWire (in dark blue) and the secondary tibial graft-passing suture (in light blue) out of the inferior tibial incision. The free No. 2 FiberWire is pulled second, retrieving the ABS TightRope out of the inferior tibial incision. The secondary graft-passing suture is pulled third, docking the tibial side of the graft into the tibial socket. Finally, the ABS TightRope is tensioned, after the external ABS Button has been attached.