Cruciate ligament plasty

During cruciate ligament surgery, we remove the semitendinosus and gracilis tendons through a small oblique incision on the inside of the tibial plateau. The graft is made from these two tendons to replace the anterior cruciate ligament. In order to achieve better blood circulation and healing of the tendons, we do not completely detach the tendons from the tibial bone, but leave them in place. A drill channel, the diameter of which depends on the thickness of the tendon and is determined intraoperatively, is drilled through the tibial plateau under camera vision.

In accordance with modern guidelines for cruciate ligament reconstruction, a corresponding drill channel is then drilled from the medial arthroscopic portal (anteromedial drill channel in the femur) into the femur. The semitendinosus and gracilis tendons harvested as grafts are then hooked into the ACL TightRope and pulled into the joint through the channel in the tibial plateau and then also pulled through the channel in the femur under camera view and secured with the TightRope and tightened accordingly.

We almost exclusively use the ACL-TightRope offered by Arthrex to fix the cruciate ligament replacement on the femur. This ingenious thread system, which fixes the ligament to the thigh using a small titanium plate and creates a tension for the graft that is easy to control intraoperatively, requires a little more material, but we believe that the benefits of better regeneration and remobilization justify this effort.

The tendons are fixed to the tibial plateau using an absorbable interference screw, which is also made by Arthrex. At the end of the operation, a drainage tube is inserted into the knee joint, which is removed the following day before the patient is discharged from our clinic.