Name: ACL/PCL Graft Options and Preparation
Uploaded: 2014-09-05T00:00:00Z
Channel: Arthrex
Description: Adrian Wilson, MBBS, (Hampshire, UK) discusses the anterior and posterior cruciate ligament (ACL/PCL) reconstruction technique utilizing GraftLink®. Dr. Wilson demonstrates the graft preparation for both GraftLink and TriLink, using the new #2 FiberWire® on double loaded Straight Needles. Dr. Wilson also demonstrates the use of ACP (Autologous Conditioned Plasma) in his graft preparation.

<p>Adrian Wilson, MBBS, (Hampshire, UK) discusses the anterior and posterior cruciate ligament (ACL/PCL) reconstruction technique utilizing GraftLink®. Dr. Wilson demonstrates the graft preparation for both GraftLink and TriLink, using the new #2 FiberWire® on double loaded Straight Needles. Dr. Wilson also demonstrates the use of ACP (Autologous Conditioned Plasma) in his graft preparation.</p>

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VPT1-00262-EN | A | ACL/PCL Graft Options and Preparation

Professor Adrian Wilson

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ACL/PCL Graft Options and Preparation

So I'm going to talk to you about ACL and PCL graft options and preparation. I'm going to concentrate on GraftLink touch a little bit on TigerLink and how we prepare that and also introduce the idea of graft reinforcement. And if we do have a short graft how we can extend that. And then like Jim, I'm going to finish with some of my own results and those of some other surgeons that have presented. So in terms of our graft choice, All-inside gives us a great option of being soft tissue preserving and bone preserving because we're using a single semi tee. And as we've heard, we can do that through a very small, minimally invasive approach through the posterior harvesting technique. Now we preserve the gracilis. And this gives us stability, strength and proprioception, but also allows us to do other reconstructions which are becoming more and more important to us, such as the ancestral ligament. Or we can do a Larsen, a lateral collateral ligament, or, in rare cases, other reconstructions such as the mpfl. We can combine a semi tee and a gracilis to make an eight strand GraftLink where we need. And if we need to use allograft, we only need to use one. And that's a huge cost, saving their 2,000 pounds in the UK and just using one for an ACL. Saves a lot of money. The semi allografts can come pre-prepared from Arthrex and we frequently use peroneus longus and tibia in my practice. There's this fantastic new technique now for minimally invasive harvesting for a quads tendon. And there are some great instruments to do this. And this is a very good option that I suggest you look at. So how do we make the GraftLink in 2014. Here we have our semi. We bring the ends together. There are some very nice two FiberWire double needles sutures. Now that make it even easier. So we can tie the knot together. We invert this knot into the central aspect of the GraftLink to make it low profile. And then using the straight needles, we can control the graph with one hand and then run the needle through with the other by leaving the needles attached. We don't even need to to use to detach these needles. We simply leave them attached and then make our second pass. So here I've done my first cerclage and I'm now going to do my second locking suture. We do two on the femoral side and we do 1 or 2 on the tibial side, depending on your preference. I just do one. So here I'm coming through to complete on the femoral side. And then I repeat this on the tibial side. So for PCL GraftLink we can use a semi. It is enough. In a big patient I would often use a peroneus longus or a tibialis anterior. And several authors have now published on this including myself, with very good results. We can combine a gracilis and a semi to make an eight strand graft, and we can do this where we have a small semi T. In our series the average size has been 8.6. Obviously a very nice size, but occasionally in the small female this may come out a little small and I use this for revision procedures. So the tri link. This is actually a very easy graph to make. Jim touched on it in his in his earlier talk. So zero FiberWire just to bring the ends together, two PT TightRope and a third, and then we simply fold the graft in two, and then we can play with the length of this to make a very slightly longer am and a very slightly shorter PL, and then it's just a simple matter of locking the tibial end in the standard way to make our tri graft. We've used this successfully in the PCI. I think this will be a where it's adopted. First you get fantastic femoral filling. So here I'm coming in with my Al. And this is a peroneus longus allograft. And the nice thing about this is the ease with which you can pass on the tibial side using the all-inside technique. So my results, which we're hoping to publish very soon, are two year results, 237 patients. We have 164 with more than a year. And we're coming up now for 100 at two years. Like Jim, I'm very happy. These are the best ACLs that I've done to date. Very good. In terms of the course and the Tegna and very few failures. 4%. And of those patients, virtually all of them went back to sport a little early and had further significant trauma. We have had one PE recently, but the complication rate has been very favorable. Jim has already shown these, so other surgeons are now presented through the SOS system, combining their data to show a comparable to the BTB gold standard of the Womac, the SF 12 and the and the pain scores. And we've just heard about this study from Philippe, who's recently presented this 46 patients. And they looked at one month at their results. They had a better position using FlipCutter on the tibia, a better range of motion, better stability with the rolling meter. And but the principal finding was significantly less pain with it all inside versus their traditional hamstring group. So in summary, All-inside preserves the gracilis. It preserves it for stability, strength, and proprioception. We can use this for other ligament reconstructions. We have graph reinforcement for small graphs, for extra articular procedures, and for multi ligament reconstruction we can lengthen graphs. And I'm presenting some really very good results for my GraftLink series at two years. Thank you very much.

ACL/PCL Graft Options and Preparation

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