WHAT TYPES OF GRAFTS ARE USED?
Anterior cruciate ligament tears are very common knee injuries, especially for professional athletes or individuals who participate in sports. Modern orthopedics employs the arthroscopic technique and reconstruction using tendon autografts in order to combat this type of knee injury.
Nowadays, three types of tendon autografts are commonly used in reconstruction surgery: the hamstring tendon, the patellar tendon and the quadriceps tendon autografts. The graft choice is personalized, and the orthopedist selects the appropriate graft by taking into consideration various additional factors in each patient.
WHY IS THE HAMSTRING TENDON USED?
Use of the hamstring tendon results in excellent clinical outcomes–as long the surgeon is technically qualified– but has the disadvantage of not including a bone block. This means that the incorporation of the hamstring tendon in the femoral and tibial tunnels is delayed. On the other hand, harvesting the patellar tendon– which is still considered the ‘‘gold standard’’ for anterior cruciate ligament reconstruction– is criticized for causing anterior knee pain, tendonitis, hypoesthesia due to injury of the sartorial branch as well as a large, longitudinal incision that is made to harvest the graft.
WHY IS THE PATELLAR TENDON USED?
The Swedish knee arthroplasty register reports a resurgence of orthopedic surgeons who opt for patellar tendon autografts since modern tools have now eliminated former disadvantages that were associated with donor site morbidity. In March 2016, the innovative surgical technique of percutaneously harvesting patellar tendon grafts was published (Intzoglou KS, Hoffman A, Seil R) in the acclaimed European journal Sports Orthopaedics and Traumatology. This surgical technique minimizes incisions as well as postoperative anterior knee pain around the patella.
This innovative technique is considered ideal for providing a faster and stronger incorporation of the graft after anterior cruciate ligament reconstruction, a quick and safe return of the athlete to athletic events, and the elimination of side effects caused by traditionally harvesting the patellar tendon graft (pain, tendonitis, incisions).
RECONSTRUCTION USING THE PATELLAR TENDON
This innovative technique can be incorporated with the implementation of rectangular femoral tunnels, which accurately mimic the normal anatomical structure of the anterior cruciate ligament. In the past, round femoral tunnels were originally used for anterior cruciate ligament arthroplasty. Based on scientific research and experience by Fink C. and Hoser C. from Innsbruck, Austria, the rectangular parallel tunnels with rectangular cross-sections are currently used to 100% restore the normal anatomical structure of the anterior cruciate ligament.
Our center was the first in Greece to ever apply this method. It is considered to be ideal for revision ACL reconstruction because bone blocks of the patellar tendon graft can be used for tunnel filling. This is why, in most cases, revision surgeries can be a one-stage revision and not a two-stage revision process.
WHAT HAPPENS AFTER THE SURGERY?
Postoperatively, knee braces are not always necessary. Physiotherapy sessions, as well as strength training exercises for quadriceps, hamstrings and gastrocnemius are important in order to maintain range of motion of the knee joint. The duration of rehabilitation is shortened since the graft used for ACL reconstruction is incorporated in a faster and safer way.