Name: Live Case: TightRope® SB Implant and Quad Autograft for ACL Reconstruction
Uploaded: 2026-09-02T04:00:00Z
Channel: Arthrex
Description: Rachel M. Frank, MD (Denver, CO), treats a patient with a full ACL tear using the all-suture TightRope® SB implant and a quadriceps tendon autograft. Dr. Frank also discusses her use of the QuadPro™ tendon harvester and reviews graft preparation steps.

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Rachel M. Frank, MD (Denver, CO), treats a patient with a full ACL tear using the all-suture TightRope® SB implant and a quadriceps tendon autograft. Dr. Frank also discusses her use of the QuadPro™ tendon harvester and reviews graft preparation steps.

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VID1-008199-en-US | A | Live Case: TightRope® SB Implant and Quad Autograft for ACL Reconstruction

Rachel M. Frank

A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

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Live Case: TightRope® SB Implant and Quad Autograft for ACL Reconstruction

Speaker  Hey everyone, it's doctor Frank here. We're getting ready for a busy day of surgery. Our first case up is a patient with a complete ACL rupture. You can see here on the MRI complete ACL tear, pivot shift, bone bruise pattern. An amazing candidate to undergo ACL reconstruction. Our game plan is an ACL reconstruction using quad tendon autograft with the TightRope soft button with internal brace. Let's go operate. We begin with the quadriceps tendon Autograft harvest. We do this by making an incision approximately 2 to 3cm in length, starting approximately one fingerbreadth above the superior pole of the patella. After we incise through the skin, we'll get through the subcutaneous tissue and we'll get down to the peritenon of the quadriceps tendon. Then we'll use the QuadPro harvester to mark our starting point on the superior pole of the patella. We'll then use a number 15 blade scalpel to dissect the distal aspect of the quad tendon in a full thickness fashion. Once we've dissected the tendon for about 3 to 4cm, we'll whipstitch the distal aspect of the tendon. Next, we'll use the QuadPro harvester to go ahead and harvest our quadriceps tendon, aiming toward the superior aspect of the tendon in 360 degree fashions will aim for a depth of about 65 to 70mm in most patients. Once we've achieved our desired length 65 to 70mm, we'll use the push rod to amputate the quadriceps tendon proximally. Speaker  You can see a nice full thickness quadriceps tendon harvest. And then we'll go to the back table. And this is where the soft button technology will really shine. You'll use the graft clamp like you would with any other FiberTag TightRope, and you'll prep the TightRope onto the graft the same way that you would prior to the soft button technology going up and down through the FiberTag. But now we're going to really see what the FiberTag TightRope soft button technology is all about. The yellow portion that you see is the button that's replaced the metallic cortical button, and by pulling on the included TigerWire and FiberWire sutures, we can elongate the button so that it'll pass through a cortical hole. We'll do the same thing on the opposite side of the graft. And in this case we're showing the internal brace. So this will be used on the femoral side of our graft fixation. Next we'll compress the graft and the compression tube's on the back table so that we can get as tight of a draft as possible within our tunnels to get a nice solid ACL reconstruction. Maintain the graft on tension on the back table with a vancomycin soaked saline sponge. After the graft is prepared, we'll get back to the knee and start our preparations for ACL tunnels. Speaker  I like to drill my femoral tunnel through an Anteromedial portal approach with the knee hyperflexed. We'll drill our drill pin in place, and then we'll ream with a low profile, rigid reamer to the depth of about 22 to 23mm. The size, depending on the size of your graft. And we'll go ahead and pass a passing suture. Next we'll assess the integrity of our femoral tunnel from the medial portal. Next we'll go ahead and drill our tibial tunnel using the FlipCutter. This allows us to create an all inside ACL reconstruction using the low pro rigid reamer on the femur and the FlipCutter on the tibia. We retro reamed to a depth of about 25 to 30. Again with the size based on the size of your graft. We'll go ahead and pass a passing suture. We'll collect both passing sutures for the femur and tibia. And now we'll get ready to pass our graft. Our graft has been previously prepared. Soaking with vancomycin soaked saline under tension on the back table. Now we'll get ready to go ahead and pass our graft. And first we'll pull up into the femoral tunnel. Through the femoral tunnel, we'll pull our leading blue FiberWire sutures, as well as the TightRope white sutures through that cortical hole on the femoral tunnel, which can be 4 or 4.5 millimetres, depending on your preference. Lots of options for you. Speaker  You'll see we're elongating the TightRope soft button by pulling on the blue leader sutures out laterally against the white TigerWire sutures out the medial portal, and that elongates the button. You see me switching my scope over to the medial portal to watch that soft button go up into the femoral socket, and then go through that cortical hole on the lateral femur. Again, you're drilling that typically with a four or a 4.5mm reamer, or you're using your FlipCutter to make that hole on the lateral cortical wall. Here, we're going to watch that TightRope go into that cortical hole, and then flip just on the lateral cortex of the femur. And we're doing that by keeping the button elongated by pulling on those TigerWire and FiberWire sutures. Now that we've flipped our button, we can pull back on the graft InternalBrace or both, as you see me doing here. And really make sure that button is tight against the lateral femoral cortex. I like to take an X-ray intraoperatively with the mini fluoroscopy to confirm the appearance of the button. And the versatility of the soft button is that if I don't like anything, I have an opportunity to adjust the soft button before I tension my graft. We like the position of our button. We're happy with everything. So now we'll get ready to bring the graft up into the femoral socket. Speaker  Here, I'm marking the TightRope sutures with a sterile marking pen so that I know I'm keeping my TightRope even. Next, we don't have to worry about the blue leader sutures or the TigerWire trailing sutures. Those are done at this point, and we're simply going to use our tightrope sutures to shuttle our graft up into the femoral socket. I like to get about 15 to 20mm of collagen up into the socket. And then I know that I have a really nice biologic tight fitting construct in the femur. Next, I will elongate the soft button by pulling on the blue leader FiberWire sutures against the white trailing TigerWire sutures to elongate that button. So now that we've secured the graft into the femoral socket, we'll go ahead and pass the graft into the tibial socket. We will use the FiberSnare that we previously collected out the Anteromedial portal to pass all of our sutures on the tibial side of the graft, including the InternalBrace FiberTape sutures down the tibial tunnel. As you can see here, I've already passed all of those sutures down. So now we're pulling all of the sutures down the tibial tunnel to maintain the elongation of the soft button. We'll leave our TigerWire sutures out the medial portal and we'll pull opposite those the leading blue FiberWire sutures as you see here just like we did on the femoral side. Speaker  And then we'll pull that. We'll pull tension on those two sutures, and then we'll be able to pull our button through that tibial tunnel through the FlipCutter hole. Next, we'll discard our TigerWire sutures because we no longer need them, because our buttons are where we like them. Once we've secured our graft into the tibial socket, we'll go ahead and cycle the knee 10 to 15 times, maintaining tension on the graph the entire time. And then we will begin our tibial fixation. Here I'm showing the features of the TightRope soft button. We're elongating the button using the TigerWire sutures against the FiberWire sutures. We no longer need to do that at this point because the button is outside the cortex. But just illustrating how this works. Once you're done with the elongation of the button, you can discard the FiberWire and TigerWire sutures as you see here, because we no longer need to elongate the button. Next we will go ahead and tension our ACL graft just a little bit. Not all the way because I like to tension my internal brace first. But here I'll get the button down about 8,090% just basically. So it's resting on the cortex. But I like the graph to be tensioned last. So we'll do our final tensioning later. Next we will go ahead and secure our internal brace FiberTape sutures. Speaker  We'll drill. Then we'll tap the cortical bone. And then we'll place the FiberTape into a 4.75 SwiveLock suture anchor. And we'll get that down just distal to the tibial tunnel aperture. Now you can see I'm final tensioning the graft using the TightRope soft button on both the tibial side, and I have the opportunity to do that on the femoral side as well. I typically do that with the knee at about 10 to 20 degrees of flexion, and I do my internal brace at full extension or full hyperextension. Next we'll go back to the scope. We'll make sure we love the appearance of our graft. We still have opportunity to retension our graft on either the femur or the tibial side using the TightRope soft button technology. You can't see the internal brace FiberTape, but they are resting behind the graft in this case. We'll then final check our exam with an intraoperative lachman and we really have no motion in this case. Just finished up with surgery. Acl reconstruction quad tendon. Autograft. Fibertag. Tightrope. Soft button on both the femur and the tibia. Internal brace. As you can see here on the intraoperative fluoroscopy X-rays, we can see the TightRope soft button on both the femoral and tibial sides. Looks amazing. Super excited about this technology and can't wait to see this athlete get back to sport.

Reconstrução do LCA com autoenxerto do tendão quadricipital

TightRope® SB Implants

Live Case: TightRope® SB Implant and Quad Autograft for ACL Reconstruction

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