ACL Reconstruction – 10 Tips and Tricks

    Johan Bellemans, MD, from the Leuven University Hospitals in Belgium, offered attendees at the 13th Annual Insall Scott Kelly Institute Sports Medicine, Total Knee and Hip Course in New York his advice on achieving success with an anterior cruciate ligament (ACL) reconstruction:

    • Position the patient yourself to ensure his or her knee can be moved between 90 degrees and hyperflexion during the procedure.
    • Make sure you have a solid graft; Dr. Bellemans recommends a thickness of 8 mm. He said, in fact, that the thickness of the graft is the most important prognosticator in avoiding graft rupture.
    • Visualization of the operative site is important. Remove as much of the Hoffa as necessary to properly visualize the key anatomic landmarks and structures.
    • If the anteromedial and posterolateral bundles are intact, leave them; they will make the graft thicker.
    • Be sure to treat the notch. If it’s open, don’t touch it; if it’s gothic, open it with a notchplasty.
    • When making your tunnels, check and recheck the anatomic landmarks. Create a routine for yourself: Always use the same guide, the same angles, and the same position.
    • Bevel your tunnel edges. The tunnel edges, which will fret against the graft, can be very sharp, so make them smooth. In addition, remove all bone debris to avoid calcification in the joint.
    • Be consistent in your fixation. Know the strength, stiffness, and slip ratio of your system.
    • When you’re done, go back and evaluate the graft. Look at what has been done and determine if it needs to be cleaned up.
    • Safeguard the reconstruction. Avoid early recurvatum when transferring the patient from the operating table after the procedure.