ACL Reconstruction - Quadruple Hamstring Surgery

 

1. Tendon Removal.
A 1½" incision is made. The gracilus and semi-tendinosis are harvested using a tendon stripper.

Remove tendon

 
 

Drill tunnels

 

 2. Tunnels.
A hole (tunnel) is drilled in the upper tibia (lower leg bone) and exits into the center of the joint at the original ACL insertion. Drilling continues until another hole is drilled in the femur (upper leg bone). These tunnels will be used to insert the hamstring tendon.
 

3. Rod is inserted.
A rod is inserted into the tibial and femoral tunnels. A device, RIGIDfix Cross Pin Guide Frame, is then inserted over the rod, through the tibial tunnel into the femoral tunnel. The RIGIDfix Cross Pin Guide Frame is used to determine the correct location for drilling tunnels in the side of the femur.
 

 Insert rod

 

Drill lower pin site

 

 4. Drill lower pin site in the side of the femur.
Using the RIGIDfix Cross Pin Guide Frame, the lower cross pin tract is drilled.
5. Drill upper pin site in the side of the femur.
The upper pin is drilled and a sleeve left in both pin sites. The guide is removed, leaving the femoral sleeves in place for the transfix pins.
 		 Drill upper pin site

 
Insert hamstring graft

 

 6. Quadruple hamstring tendon graft is inserted.
The four strand hamstring graft is pulled through the tibial tunnel into the femoral socket and held tightly.
 
 

7. Hamstring is anchored.
A very strong, bioabsorbable pin is inserted into the upper sleeve, through the hamstring tendon into the bone. This pin will anchor the hamstring to the bone. A second pin is used to anchor the hamstring through the lower sleeve.
 

Anchor to femur

 

Remove sleeve

 

 8. Remove Sleeves.
Both sleeves are removed from the femur. The new ACL is now anchored firmly into the femoral bone tunnel. Next, the graft will be anchored to the tibia

 
9. Attach the Tie Tensioner to the graft.
The quadruple strands are attached to a tie tensioner. The tie tensioner equally tensions and separates each strand of the four strands of the graft.
 

.Attach tie tensioner

 

Compress graft

 

 10. Compress the graft with the Sheath Trial.
The sheath trial will separate and compress the tendon against the bone of the tunnel, while preparing the tunnel for the sheath.
 
11. Insert the Sheath.
Continuous tension is applied to the four tendon strands as the ribbed sheath is slowly inserted and advanced until it is flush with the outside of the bone.
 

Insert sheath

 

Insert screw

 

 12. Insert a screw into the sheath.
With the knee slightly flexed, a screw is inserted into the sheath to expand it outward compressing the four tendon strands firmly against the bony walls of the tibial tunnel.
 
13. Graft is anchored to tibia.
Each tendon bundle is uniformly compressed against the bone without overlap. This encourages rapid growth into the bone of each strand of the quadruple hamstring graft.
 

Anchor to tibia

 

New ACL

 

 14. Strong, stiff hamstring graft.
The hamstring graft in now anchored to the tibia. Excess graft and sheath material is trimmed.
 

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3/1/2006

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