Name: ACL Reconstruction With ALL Reconstruction Using the TightRope® II Implant, FastThread™ Interference Screws, and Knee FiberTak® Anchors
Uploaded: 2025-10-13T00:00:00Z
Channel: Arthrex
Description: Prof. Etienne Cavaignac, MD (Toulouse, France), demonstrates an ACL reconstruction using a TightRope® II implant together with an ALL reconstruction as a lateral extra-articular procedure (LEAP) using two double knotless Knee FiberTak® anchors.

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Prof. Etienne Cavaignac, MD (Toulouse, France), demonstrates an ACL reconstruction using a TightRope® II implant together with an ALL reconstruction as a lateral extra-articular procedure (LEAP) using two double knotless Knee FiberTak® anchors.

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VID2-007953-en-US | A | ACL Reconstruction With ALL Reconstruction Using the TightRope® II Implant, FastThread™ Interference Screws, and Knee FiberTak® Anchors

Prof. Etienne Cavaignac, MD

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ACL Reconstruction With ALL Reconstruction Using the TightRope® II Implant, FastThread™ Interference Screws, and Knee FiberTak® Anchors

Hello, everybody. My name is Etienne Cavaignac. I come from Toulouse. Today I will show you the technique I use for ACL and reconstruction for ACL. I will use the summit fold. Fold in 3 or 4. Keep, attach and put inside. And for the ll, I will use the fold in two with a two percutaneous incision. So first of all I will average the graft. The landmarks are tibial tubercle like that. And I can see the end of the tibial plateau there. And most of the time I can feel the graft there. And for the ll the landmarks are the gerdy's tubercle and the lateral epicondyle there. So I will do my incision proximal and posterior and just posterior there. As I'm very focused in the efficiency in the war, I would like to use my knife just one time. So I will first of all do my incision for the hamstring here. And I keep it I do immediately. The incision for the anterolateral ligament I contacted to the bone like this. And here I put my finger onto the lateral epicondyle there, and I go onto the bone. So once you open the skin, just be sure that the incision is big enough to put everything inside. So I've got one here. I put a drape here to protect the skin, and I pull as strong as I can to make it go out. It's really easy for me to catch it after that. With the full flexion, I can see the vinculum. You see the vinculum here, the vinculum there. I can cut that one. I can feel that everything is moving. I put the stripper there. Here we go. Okay. The stripper. Okay. That's nice. So those are my two graphs. So is the big one. And the second one the summit will stay. We keep attached to have a double fixation on the tibial side. And for the gracilis I will just take out this one in real life I put vancomycin on that to have vancomycin soaking to avoid the infection, and I put it inside during my surgery so it stay clean inside the joint. So it's the left knee. I put my finger there. I can feel the soft bone there, soft soft point there, and I go very high to avoid the fat pad. Then I feel my medial, the medial condyle. There I go, very low, and I do. For a small incision like that. It's very I prefer to have different level of incision so I can work in 3D. I will try to keep as much remnant as I can. Okay, so I don't touch that part. I go only here, close to the femoral footprint. Open here. So I love to keep as much as I can. So as you can see on that device, the mark is very posterior. So don't put it to entirely. You go very posterior like that. Okay. Nice. Nice. Perfect. I will start with a 5 millimeter or 6 millimeter drill. I close to the context. So I go very slowly. And you see I'm inside inside the ACL. I try to keep this very intact. I will control the position of the pin to be very, you know, you see, I can go entirely. I can go posteriorly and I try to have as much as I can until the top of the ligament. We consider the massage of the ACL. You see, we open that space ACL massage. It looks like a like a sleeve. I'm inside. I try to go as far as I can. Okay. We can see the shaver there. So I will use my clamp to put the graft in that position. Okay. Thermal device, please. Okay. I can see that my pin is close to where the graft was. Okay. Let's go. So now I will check onto the skin. The length there is 55. I'm in contact. Contact the cortex 55 and I will drill 20 20mm to centimeters. Okay. Okay, so here's the switchover. Okay. So I put the suture at the end of the tunnel there. To know the length I need. Okay. Nice. On to the insertion of the symmetry. Okay. Okay. And I can measure the length from the top to the insertion. In that case, it will be around 9.5cm. Could you write this on the table? 9.5mm. As I'm in that position, I will go for the for the for the fiber attack right now. So I let the camera in that position so I can control if there is any convergence of the tunnel. Here we are. Okay. Here we are. Sorry. Okay. And it works well. Very hard. Okay. And I will do exactly the same on the tibial side. It's very important to understand here that the shape of the tibia at that part is like that. Okay, so I have really to be onto the bump. If I'm below, I will go down and it's not good. So you have to stay posterior to this record. Imagine this record is here. But stay in contact with the bump so I can feel it. Put it inside. Got distracted there. I'm too. I'm too disturbed. And here. I'm okay. Okay. Control that. Everything works. It works. So now I did all the tunnels. I did the fixation device. I just have to prepare the graft. 3.5. And 9.5. Okay, so I know the length in between the insertion and the end of the tunnel and the length in between the insertion and the beginning of the tunnel. The graph is kept attached. I need the tightrope, please. You have to increase the size The people will help you for the surgery will put in contact. So you have to control the length here and the tension at the same time. Okay, close to it. Now the symmetry is folding two here and here to be sure that everything is at a good place. I will just fold in three in that case, because the tendon is quite big. So I have a fold in three. So now we have a graft cap attach here. Three advantages vascularization innervation and secondary fixation. You put everything in that passing suture. Be careful to really hold the tie. Drop the metallic part of the tie drop with your finger. Here. Don't put it inside you. First of all, you go with the suture and then you put the tie drop inside. You will see it. Okay. I will control where I am. Okay. Could you come with me? Okay. I feel the cortex, I feel okay. Okay. Now it's good. Just by pulling on the. It's coming inside. Now. It's down, it's inside. I'm not afraid to pull too much because there is a secondary fixation. You see the graphs? The graph is here. Here it's inside and complete. And we have we still have the, the antero medial attachment of the graft there. 15 degrees of flexion please. And I go inside I can feel the cortex. The good noise. This is the cemetery there. The cemetery is still attached. There you can see. So there is a second refixation. The tunnel is there, I can feel the screw. And the second fixation is the. So the ACL is done. So I have to pass underneath the ITB. So I have to feel where is the ITB. And I go down directly to my incision. So at the same time I have the passing suture and the gracilis. Everything is here okay. So I will need another clamp please. This will help me to put the graph down back to the to the tibia. After. Okay. And then. Okay. The middle is almost. And I pass the graft inside both loop okay. Okay. You see the graph coming on to the cortex. Nice second one okay. It's perfect. And I can put very strong on that okay. Now I have to go back. With the other part. The good advice is to put the finger there. Is it this one? Okay, okay. You can. Okay. And it's here. So we have double strand gracilis. Open to over one loop. I try to put the pincer inside, take both parts. Okay. Okay. And then full, full extension, please. Could you hold that one? Sorry. Yeah. Now we want step by step. Okay. You will see the graph here coming onto the cortex. Okay. Nice. Same second time. Okay. The graph is completely against the cortex. Okay. I can feel it. Okay. Knife, please. And you just have to cut to cut. It. And you have your ill done. So I was very happy to show you that combined technique about ACL and IL. There is some points that I have to highlight. First of all, the biological aspect of the surgical technique, if you keep attach there, keep as much remnant as you can, you will improve the results. Then you can do the the IL with a percutaneous technique. You don't have to open too much with a gracilis fold into that can improve the stability of your knee and improve the long term results of your ACL reconstruction. So it's a very efficient technique. As you can see. You can do it very easily in the lab. Takes five minutes with a if you are well trained. So it's not really a problem of, of increasing the the length in the ER. So I will appreciate the technique. It's a straightforward technique. And if you have any questions please ask your arthrex rep.

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ACL Reconstruction With ALL Reconstruction Using the TightRope® II Implant, FastThread™ Interference Screws, and Knee FiberTak® Anchors

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