Revision Anterior Cruciate Ligament Reconstruction with Doubled Semitendinosus and Gracilis Tendons and Lateral Extra-Articular Reconstruction by Andrea.

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Presentation transcript:

Revision Anterior Cruciate Ligament Reconstruction with Doubled Semitendinosus and Gracilis Tendons and Lateral Extra-Articular Reconstruction by Andrea Ferretti, Fabio Conteduca, Edoardo Monaco, Angelo De Carli, and Carmelo D'Arrigo J Bone Joint Surg Am Volume 89(2 suppl 2): September 1, 2007 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Preoperative lateral (left) and anteroposterior (right) radiographs showing a failed anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft. Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

T1-weighted magnetic resonance image of a failed anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft. Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Extensive bone loss due to convergence of tibial tunnels is managed with Evolgate fixation and grafting: A: bone loss; B: the Evolgate device (Citieffe, Bologna, Italy); C: preparation for Evolgate insertion; and D: Evolgate inserted with tendon passage. Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Failure of anterior cruciate ligament reconstruction due to an anteriorly placed femoral tunnel. Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Positioning of the patient on the operating table. Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Location of the central transtendinous arthroscopic portal. Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Intra-articular view of a failed anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft due to graft elongation. Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Removal of an interference screw with an arthroscopic grasper. Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Localization of atibial fixation device with the aid of fluoroscopy. Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Semitendinosus tendon stripping. Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Lateral hockey-stick incision. Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

The iliotibial tract is incised along its fibers (A), after which the vastus lateralis is retracted, exposing the lateral femoral condyle (B). Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Tendons mounted on the workstation. Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Reamings from the drill are collected and used for grafting. Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

The Evolgate device is composed of three titanium-alloy components: a coil (a spiral 21 mm in length and 10 mm in diameter) with a spike positioned at one extremity, a 9 × 20-mm screw, and a washer. Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

A, B, and C: Insertion of the coil of the Evolgate (Citieffe) in the bone tunnel. Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

The Swing-Bridge (Citieffe) device consists of a titanium-alloy cylinder (diameter, 10 mm) with a smooth metal half-ring (diameter, 10 mm) at one end and a shelf with grooves at the other. Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Final fixation with screw and washer. Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Andrea Ferretti et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.