Anterior Cruciate Ligament (ACL) Tears: BTB ACL Reconstruction With Tensionable Suture Implant and Absorbable Screw Animation

This video is an animation of an ACL reconstruction using a bone-tendon-bone graft. The graft that is used is the patellar tendon from the front of the knee, keeping a bone plug attached at each end, one from the kneecap and one from the shin bone. This graft can either be an autograft from the patient or an allograft donated from a cadaver. The bone-tendon-bone ACL reconstruction in this right knee starts with drilling a socket in the thighbone, or femur. A special guide is used to make sure the drill aims at the right spot inside the knee. Once the tip of the drill bit is inside the knee, the guide is removed. The drill sleeve remains and is tapped into the bone, so the surgeon does not lose the spot. The FlipCutter has a tiny blade that flips out inside the joint, and then the surgeon pulls back on the drill, creating a bone socket from the inside out. With the drill sleeve still in place, the surgeon passes a special suture with a loop at the end into the knee. A full tunnel is then drilled from the outside in through the shin bone or tibia, and the loop from the suture is pulled out of this tunnel. The surgeon then passes the bone-tendon-bone ACL graft up through the tibia, and then slowly brings the first bone plug into the socket that is in the femur. Similar to the all-soft tissue grafts, the sutures have a small metal button on them that will be flipped on the outside of the bone. Then, the tensioning sutures are pulled as the surgeon slowly guides the bone plug into the socket. Since the graft was pulled into the knee through the tunnel in the tibia, the second bone plug is already in place in the tunnel. The surgeon will straighten the knee and, if applicable, fix an extra FiberTape suture into the shin bone with an anchor. Using this extra FiberTape suture, called the InternalBrace technique, augments or supplements the graft during the early phases of healing. Next, the surgeon will place a larger screw in the tunnel in the tibia to lock the second bone plug into place. All of the extra sutures are cut and removed. Finally, the surgeon will check the tension on the graft and can always go back and retighten if needed. Here is the final ACL reconstruction.