Arthroscopic interventions on the knee joint are standard procedures today. The number of injuries to the capsule-ligament apparatus of the knee joint has significantly increased over recent decades. This is primarily due to the intensive leisure activities engaged in by large sections of the population. Various types of ball sports and skiing are some of the activities that put significant strains on knee joints. Acute injuries to the knee joint can be identified using non-invasive diagnostic procedures, such as magnetic resonance imaging (MRI).
The anterior cruciate ligament is one of the most frequent ligament injuries when the knee joint is damaged. These ACL ruptures are frequently encountered as combined injuries where muscular lesions form 75% of the problem.
ACL reconstruction – Arthroscopically supported reconstruction of the anterior cruciate ligament
There is no single optimum surgical technique in modern cruciate ligament surgery. Many factors need to be weighed up and play a part in the decision about the optimum therapeutic concept for the particular patient. Irrespective of whether the patient is an elite athlete or a normal individual, or whether the intervention relates to a revision operation or an initial rupture, graft selection, graft preparation, and fixation system are only a few of the aspects that need to be taken into account for optimum care.
The anterior cruciate ligament set using the semitendinosus tendon has attracted increasing interest over recent years. This technology combined with the product range of Richard Wolf enables ACL reconstruction to be performed using the tendon and fixation options set out here:
- ACL reconstruction with patellar tendon
Fixation with PressFit technique or using BioactIF OSTEOTRANS interference screws
- ACL reconstruction with quadriceps tendon
Fixation in PressFit technique or with BioactIF OSTEOTRANS interference screws
- ACL reconstruction with hamstring, semitendinosus, gracilis tendon Fixation in BioactIF OSTEOTRANS interference screws, RIWObutton fixation anchor or with T-Lock OSTEOTRANS tendon anchor
ACL reconstruction with semitendinosus tendon and femoral fixation of the cruciate ligament with RIWObutton
Reconstruction with a fixation "button" is the most widespread technique. However, disadvantages have been described for this fixation in the literature although there are a large number of advantages and a high level of standardization for this surgical technique. Nevertheless, using a fixed tape loop could significantly reduce the cyclical change in length of the graft in the drill tunnel when movement occurs.
Fixations near the insertion...
...with BioactIF OSTEOTRANS
Advanced ACL surgery is inconceivable without graft fixation using bioresorbable interference screws. The requirements for implants of this type are extremely diverse and complex. Biocompatibility, bioresorbability, and high pull-out strength of the fixed graft are the basic characteristics which are highlighted here since they are essential for users and patients. Furthermore, the specific, physiological material properties of the Richard Wolf implants promote bone growth into the implant, avoid inflammation and encapsulation, and promote transformation into bony material by osteoclasts.
The high-tech material "BioactIF OSTEOTRANS" has been uncompromisingly developed to meet the very highest aspirations of ACL reconstructive surgery.
...with T-Lock OSTEOTRANS
A proven surgical concept has been combined with an innovative implant to create an anatomically correct ACL reconstruction with maximum pull-out strength.
The principle is simple. The fixation of the cruciate-ligament graft in a bottle-shaped, femoral tunnel using knotted ends of the graft has been standard practice for many years. The disadvantage of this was that the semitendinosus and the gracilis tendon always had to be removed for this surgical procedure.
An obvious move was to perfect this technology. The knots were replaced by the T-Lock tendon anchor. This achieved a gain in the length of the graft and the removal of the gracilis tendon was superfluous as a result.
However, implant-free techniques with PressFit fixation are also available and they are particularly attractive for revision surgery:
An alternative solution to fixation of the cruciate ligament is provided by the Pressfit technique with significant advantages:
- Fixation near the insertion
- Avoidance of implants / hardware
ACL PressFit reconstruction with quadriceps tendon
ACL reconstruction using autologous quadriceps tendon with PressFit fixation is a proven procedure with a track record spanning decades. However, over recent years there has been a growing trend toward focusing on hamstrings when selecting a graft. The lower level of trauma experienced during removal and the range of convenient fixation implants available mean that the hamstrings appear to be undisputed as the graft of choice. However, the quadriceps tendon has once again risen to become a focus of interest and this is not simply because of the cost-effective PressFit fixation without the need for implants.
For example, the latest publications have been looking at the quadriceps tendon. It has been demonstrated that anatomical positioning of the femoral tunnel is equally possible when using the quadriceps tendon with a patellar bone block as when hamstrings are used. Significant advantages are also derived for groups of patients where removal of the hamstrings for grafting purposes is contraindicated due their stabilizing characteristics for Valgus stress. This is particularly relevant for patients who play sports like football, basketball or judo.
The surgical procedure can be divided into the following stages:
- Removal of graft with oscillating hollow burr system
- Creation of the tibial drill tunnel with harvesting of a bone cylinder
- Creation of the femoral drill tunnel
- Feeding and femoral PressFit blocking of the graft
Graftline Instrument System for arthroscopic cruciate ligament surgery
Richard Wolf has met these routine requirements of surgeons carrying out cruciate ligament operations with the graftline Instrument Set for cruciate ligament reconstruction. Innovative, modular instruments provide practical functionality to open up a wide choice of opportunities. A range of proven and new alignment devices is supplied for positioning of tibial and femoral drill tunnels in single-bundle and double-bundle reconstruction. Drill tunnels can be shaped to match the individual anatomy and optimally prepared for graft fixation. Users can chose from a selection of alternative implant systems with the necessary application and preparation instrument sets.
Richard Wolf supplies the complete product range for all standard arthroscopic procedures like meniscus resection, meniscus suture, microfracture, cartilage transplantation and ACL/ PCL reconstruction.