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

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

This animation demonstrates an ACL reconstruction using a bone-tendon-bone graft for the treatment of an ACL tear. A bone-tendon-bone graft, or B T B graft, is taken from the patellar tendon in the front of the knee. It contains small pieces of bone, called bone plugs, at the ends that are removed from where the patellar tendon attaches to the patella, or kneecap, and tibia, or shinbone. This type of graft can be taken either from the patient or from a cadaver donor.

Here, we see a right knee that is bent to expose the inside of the knee joint. First, a drill guide is placed on the femur, or thigh bone, to aim at the correct spot inside the knee and a drill sleeve and drill are inserted into the guide to make a tunnel through the bone. Once the tip of the drill is inside the knee, the guide is removed, and the drill sleeve is tapped in place. A tiny blade at the end of the drill flips out and the drill is pulled back to widen the tunnel from the inside out. A looped suture is then passed into the knee through the drilled tunnel.

Next, a drill is used to make a tunnel in the tibia, or shinbone, from the outside in, and the looped suture is pulled out of this tunnel. The looped suture is used to pull the BTB graft up into the knee through the shinbone tunnel. The graft has already been prepared with an adjustable suture device, which contains a small metal button and flat support sutures that are used to support the graft. A surgical instrument helps guide the first bone plug into the thigh bone tunnel, and the metal button is flipped out to sit on the outside of the thigh bone.

Then, the white tensioning sutures attached to the graft are pulled to fully bring the bone plug into the thigh bone tunnel. Since the graft was pulled into the knee through the tunnel in the shinbone, the second bone plug is already in place. The knee is straightened, and a hard-body anchor is used to tack down the flat support sutures to the outside of the shinbone. Then, a screw is inserted into the shinbone tunnel to lock the second bone plug in place. The sutures are cut off, and the tensioning sutures are tightened to achieve final tension of the graft. The ACL reconstruction with a bone-tendon-bone graft is now complete.