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Surgery torn anterior cruciate ligament ACL reconstruction with the hamstring technique.

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Ligamentoplasty ANTERIOR LIGAMENT (ACL) BY TECHNICAL hamstring (right-Tendons internal and semitendinosus)

The aim of this operation is to achieve anatomic ACL reconstruction using autologous (patient's tendon) under arthroscopic control.

ACL

The anterior cruciate ligament is a short ligament, very durable. It is stretched between the femur and tibia. He participates in the central pivot with the posterior cruciate ligament is behind him. It works in synergy with the external and internal lateral ligament

medial collateral ligament (MCL) is the ligament of the inside of the knee. It is long, wide and spread out. It is stretched between the femur and tibia at the top to bottom. It allows the internal stabilization of the knee.

The lateral collateral ligament (LCL) is the ligament to the outside of the knee. He is short, thin and tubular. It is stretched between the femur above and the fibular head down. It allows external stabilization of the knee

The ACL graft: the hamstring autograft. (Internal law and half tendon).

Tendons domestic law and half tendon are thin (3 to 4 mm in diameter) and long (about 25 cm)


They are the termination of two hamstring muscles few powerful ending on the crow's feet, they are palpable to the inside of the leg.



Fig 3: hamstring tendon

Arthroscopic surgery: surgical technique

Levy DIDT

Incision about 2 cm to the surface of the tibia and levy a "stripper" of domestic law and half tendon tendon. These two tendons are thin (3-4 mm diameter) but very resistant.

They are folded in half to obtain a graft ACL 4 bundles or strands 4 whose average diameter is from 7 to 9 mm.

arthroscopy

Two small incisions of 5 mm on either side of the ball will allow to move the camera and instruments to perform the ligament

The first operative step is the exploration of the knee:
essential step of the surgery, it allows for a comprehensive lesion assessment of the noble elements of the knee (meniscus, cartilage, ligaments other ...)
Treated if necessary these peripheral lesions then realizes ligamentoplasty

ACL reconstruction

Preparation of the notch, using mini motorized instruments (shaver) the fiber remains of the ruptured ACL and makes the cleaning of the graft area is removed.

bone tunnel

Bone tunnels are drilled in the tibia and femur in order to place the graft (hamstring) within the knee, at the former ligament
It uses specific sights arthroscopically, with implementation guide pin to guide the drill bit to perform drilling

Passage of the graft

The graft is passed from bottom to top in the two tunnels by a traction thread.
She will take the exact place of the old ligament



fixation:

The fixation of the graft is the last step of the operation and probably the most important because it allows to wedge grafting (primary fixation) to the healing and organic integration of the latter in the bone (secondary biological fixation ).
There are different method
interference screw, EndoButton, clip or pin
The goal is to have an excellent primary fixation, the surgeon will use the best hardware fit your situation.

Following operative:

The hospital is a few days. (3 to 6 days)
The next day, the resumption of walking in complete support possible
A splint simple protection and use two canes is desirable, not systematic.
Rehabilitation is started on the first day.
Finally a stay in a specialized rehabilitation center is not mandatory but may be desirable.
Flexible work interruption of 2 to 3 average is usual.

The recovery of a pivot sport is not possible before 6 months

Doctor Nicolas LEFEVRE, Doctor Serge HERMAN. - 24 janvier 2011.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.

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