Name: Ellison technique using Knee FiberTak
Uploaded: 2025-08-08T00:00:00Z
Channel: Arthrex
Description: Prof. Brian Devitt, MD (Dublin, Ireland), demonstrates an Ellison lateral extra-articular procedure (LEAP) by using a Hybrid Knee FiberTak.

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<p>Prof. Brian Devitt, MD (Dublin, Ireland), demonstrates an Ellison lateral extra-articular procedure (LEAP) by using a Hybrid Knee FiberTak.</p>

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VID2-007947-en-US | A | Ellison technique using Knee FiberTak

Brian Devitt, Prof.

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Ellison technique using Knee FiberTak

Hello, my name is Brian Davis. I'm professor of orthopaedics at Dublin City University and UPMC Sports Surgery Clinic in Dublin. So today I'm going to talk about the modified elephant procedure. So I'm just going to demonstrate our specimen here. We have a few markings. So just on the anterolateral aspect of the tibia we have gerdy's tubercle marked out posterior to that. Then we have the fibular head. And then on the distal femur we have the femoral epicondyle marked. So typically we leave the knee at 90 degrees of flexion. I don't change it from the position I have. My I do my ACL reconstruction in. And when I make an incision we normally would use either a ten blade or a 20 blade and make the incision. As I said distally, based on gerdy's tubercle extending proximally just posterior to the femoral epicondyle. So what I'm doing, just for the purpose of this examination, I'm going to extend the incision a little bit more approximately. But normally I would try to keep it just distal to the femoral epicondyle. This is the inferior border of the iliotibial band just here. You. And the incision was made via our skin incision here. But this will be the inferior limb of our graft. And then I'm going to go more anterior to that for to make our second limb. So we see here. So it's just going to be one centimeter strip of iliotibial band. The difference between this and the la mer procedure is we're going to detach this distally at the level of gerdy's tubercle. Okay. So normally you would extend it approximately until you see the fibers of the vastus lateralis approach. And then we just want to free it up. You can always extend it further once you've released your limb distally at the level of the gerdy's tubercle, distal aspect of the incision, it's really important that you just make sure both limbs distally. And at this stage you're on periosteum at the level of gerdy's tubercle. So I keep the knife close to the periosteum to make sharp edges. On both the posterior and anterior aspect. At this point, you can either take a sliver of bone using an osteotomy, or. What I do now is I take it off with a level of with the periosteum. I would exchange now to a 15 blade, as this is less likely to cause any skin trauma. So what I do is I try to undermine the level of the attachment to remove the periosteum and do this in the posterior limb, but also in the anterior limb as well. And you can hear that we're on periosteum there. And then we want to detach it distally. From the level of the periosteum. This is probably the trickiest bit of the procedure just to make sure you get square edges. Okay. Now we have our nice limb of our iliotibial band exposed. So you see, it's a nice rectangular end to the graft and a very nice thick graft of one centimeter. Okay, so the next thing we do now is we need to expose where we're going to make our tunnel. And this is where we move a bit more proximally to the level of the fibular collateral ligament. So now that we've got the our graph prepared, we're just going to pass our fiber loop suture tape to give us control over the over the graft. So we're just going to pass that. So we're going to go around our. Allis clamp first. Typically we need just around a centimeter or centimeter and a half of control of this. Just going to pass it through. Just it's nice to keep it neat. So we just try to make sure we get a uniform passage of our loop suture. So when we're passing it beneath the Ether tunnel around the lateral collateral ligament. We don't snag ourselves. So that one just goes a bit more proximal to your final suture to create that rip. Stop. Excellent. So now we have our graft prepared. So it's nice and robust. And you can see the graft there nicely. So we use once again our 15 blade. So we'll just get a retractor inferiorly is probably sufficient just to just underneath the lateral or the iliotibial band. And that just allows us to expose the fibular collateral ligament. You can typically feel it with your finger if you need to. If you can't feel it, you can place the knee in a figure of four position. And that makes the graph quite taut. So in this circumstance I can feel it quite nicely. So we make an incision just distal to the where the fibular collateral ligament Is based, you try to be in the proximal third of the fibular collateral ligament, close to its origin on the femur, and you make a separate incision posterior or more proximal to this. And I find that you need to make a decent tunnel so that you pass without any snagging of your graft. So typically then I would just open up my tunnel. I'd like to use a right angle. And this I'll just show you here. This allows you to get under the graft really nicely. So we go from proximal to distal first. And you need to just break through some of that capsular tissue and then open it up nicely just to make sure you get good free passage of the graft. So so what we've done now is we've passed the right angle forceps beneath the fibular collateral ligament from distal to proximal. And we've grasped our sutures from our iliotibial band graft, and we're going to pull them through the the tunnel. Okay. So just hand that to you now. So one of the key features is not to allow your graph to twist. So you want to just feed your graph through. And sometimes it needs a little bit of encouragement. Just to pull through. And now we've pulled it through. And we see it's not twisted approximately which is good. And that's what you want. You want to keep it in the same line of pull as previously. And that's our graph passage. So the next step we have now is to place our suture anchor our fiber tag soup suture anchor in the bed of Gerdy's tubercle. So I'm just going to point out exactly where the bed is. You can see the periosteum the inferior border here and the superior border there. And you can see the periosteum very clearly. So when we're placing the anchor we want to be more towards the the distal aspect of gerdy's because you want to maintain some tension on the, on the graft as you put it through. So we're going to the aspect of Gerdy's tubercle and I'm going to aim more distally and anteriorly with my with my drill. Okay. So we're just going ahead and drill. So make sure you keep your hand on the the guide so it doesn't move. And then you get your your anchor. And this is the a hybrid anchor we're using today. So we have a two limbs of suture. And we'll show you in a second. And we have a preloaded loop. Okay. Just going to wheel this a bit. Okay. There we go. That's great. And we're going to pull it back then. Okay. So there we go. We pull it back. So key to any suture fixation is just to assess your fixation. So we've given a nice firm tug and we see that that's nicely attached. So we're just going to show you what we have here. So in this hybrid anchor we've got two. To sutures here at the end, and we're going to use them to fix our graft. We've also got a loop at the end here with a cord here, which we're going to tighten up. We're going to pass them approximately half a centimeter from the end of your graph. So you want to take out a bit of redundancy. So it's important that these are going to hold your graft in place initially. And you're going to pass the second suture then. And then you have your two limbs pass through there. Okay. So now what we do is we have can take the entire construct. We want to pass it through our loop. So the prefixed loop. So just make sure we get the other side of it. And this is key just to make sure you don't snag yourself on anything. And you're going to pass all of these limbs through the loop. Okay. And then you have the configuration. We're going to tighten it. The advantage with doing analysis in procedure is because you're positioning the graft in the same position you've removed it from on Gerdy's tubercle. You don't have to be as worried about the knee flexion angle, nor the rotation of your knee of the tibia in relation to your femur. So we typically do it in neutral, and you maintain your graft at the same degree of knee flexion as you have prepared it. So keeping a good level of tension on the graft here, we can then just pull our loop. So you just want to make sure your graph is not twisting. And then you can make sure you're nice bit of tension. And you can tighten down on the loop station here. So you see your graft is nice and taut. More approximately it hasn't twisted and you can always tighten that again if you wish after a period of time. So just a little bit tighter and then you get a nice fixation with both the loop. And now at this point we can retie these sutures. So we get a double level of fixation one with the suture tape loop, and the other with the mattress suture, which we can tie. Perfect. So that's the end of our construct essentially. And then at this point, we can repair the anterior aspect of the gerdy's tubercle to the posterior aspect of tubercle. If you wish, you can repair that with the same sutures that you have here. Or alternatively, you can use a resorbable suture to repair the the distal aspect of the, of the repair. Okay. So now we're just we're a limb of the iliotibial band. So I'm just going to pass a suture through that here. And I'm going to pass the suture through the. Inferior limb then. And we can tie these, these together just to cover the graft, or else we can incorporate a further suture. You can run this suture up the length of the iliotibial band to to close it down. But for the for this purpose, I'm just going to close over the distal aspect of the iliotibial band. And just to show you our graft and its position. So the graft is nicely taut, you can see a good bit of tension there under the fibular collateral ligament. And as we bring it through a range of motion, it maintains its level of tension. So in this setting now if I was. Doing a patellar tendon ACL reconstruction, I will now put my interference screw in the tibia. And if we're using the quadriceps fiber tag we would just retension our tibial side. So the key is just to you can see it now nice and neat and good repair of that iliotibial band.

Ellison technique using Knee FiberTak

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