Anterior Cruciate Ligament Reconstruction: A New Technique for Achilles Tendon Allograft Preparation |
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| Institution: | 1. Faculty of Medicine, Memorial University of Newfoundland, St. John''s, NL, Canada;2. Orthopaedic Traumatology, Discipline of Surgery, Faculty of Medicine, Memorial University of Newfoundland, Health Sciences Centre, St. John’s, NL A1B 3V6, Canada;1. St. Luke''s Sports Medicine, St. Children''s Hospital, Boise, Idaho, U.S.A.;2. Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A.;3. Department of Orthopedics, University of Utah, Salt Lake City, Utah, U.S.A.;4. University of Utah School of Medicine, University of Utah, Salt Lake City, Utah, U.S.A.;1. Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada;2. Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada;3. Health Care and Outcomes Research, Krembil Research Institute, Toronto, Ontario, Canada;4. Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada;5. L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences, Toronto, Ontario, Canada;6. Department of Medicine, Neurology, Sunnybrook Health Sciences, Toronto, Ontario, Canada;7. Department of Medicine, Neurology, University of Toronto, Toronto, Ontario, Canada;8. Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences, Toronto, Ontario, Canada;9. Department of Laboratory Medicine and Pathobiology, Sunnybrook Health Sciences, Toronto, Ontario, Canada;10. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada;11. University Health Network – Toronto Rehabilitation Institute, Toronto, Ontario, Canada |
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| Abstract: | We describe a new technique in Achilles tendon allograft preparation for use in anterior cruciate ligament (ACL) reconstruction that allows for secure bony interference fixation on each side of the joint and aperture fixation for all patients. In addition, preparation of the graft in this manner avoids some problems that are frequently encountered with patellar tendon allografts, including graft tunnel mismatch and limited availability. Previous studies have reported successful results with Achilles tendon allograft use in ACL reconstruction with soft tissue fixation in the tibial tunnel. Bony interference fixation on the tibial side can be achieved by suturing a free bone plug to the tendon end of an Achilles allograft. We use a 9-mm circular oscillating saw to harvest a free 30-mm length bone plug from the remaining calcaneal bone block. This is then sutured directly to the tendon end of a bone-Achilles tendon allograft with the use of No. 1 nonabsorbable suture placed through 3 equally spaced drill holes in the free bone plug. Tendon length between the bone plugs can be individually set for each patient at a distance equivalent to the length of the native ACL (intra-articular distance between the femoral and tibial tunnels). After graft passage, the construct is tensioned and secured with interference screws, similar to a traditional bone–patellar tendon–bone graft. The senior author (S.G.) has performed 40 procedures with excellent results and reports no cases of tibial fixation failure. Biomechanical and long-term follow-up studies are in progress. |
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