Arthroscopic Anterior Cruciate Ligament Reconstruction: Bone-Tendon-Bone Graft Press Fit Technique

Abstract

The anterior cruciate ligament (ACL) injury is common and creates a potentially disabling knee condition for the individual. Although many patients with loss of the ACL are functionally disabled, there seems to be a small group with minimal disability. However, there seems to be no controversy in agreeing that clinically deficient ACL knee will eventually develop meniscal lesions, articular cartilage defects, and secondary stabilizing insufficiencies. This is when a full-blown picture of an ACLdeficient knee will present itself.¹ Due to significant variability of ACL injuries, evaluation methods, treatment and surgical techniques, and the precise natural history of ACL remain unresolved issues. Although one cannot convincingly argue that early surgical intervention will prevent formation of degenerative arthritis, those involved in athletic activities are prime candidates for early surgical reconstruction. There has been an evolution in surgical techniques of ACL reconstruction since the early 1980s. Arthroscopically assisted and endoscopic ACL reconstruction now is the preferred technique comparing to conventional open ACL reconstruction. Clear advantages of these methods include better joint visualization, less soft tissue and joint trauma, less morbidity, faster recovery, and ability to perform the surgery on an outpatient basis,² as well as being more economical, which is an important factor in the health care environment of today. This chapter describes my preferred technique in the reconstruction of ACL injuries, which uses the central third of the patellar tendon autograft with press fit femoral fixation.