DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20192675

Switching portal technique in anterior cruciate ligament reconstruction: use of an extra low and medial portal

Abhishek Agarwal, Ekansh Debuka, Dharmendra Kumar, Vineet Sharma

Abstract


Background: Long term success of ACL reconstruction depends on accurate surgical technique of anatomic tunnel placements and proper rehabilitation protocol followed, and for accurate tunnel positioning various arthroscopic landmark should be visible clear with the use of various portals.

Methods: All 112 surgeries were performed by a single surgeon in King Georges Medical University, Lucknow Orthopedic department operation theatre during July 2016- December 2018. An extra low and medial portal is created and then portal were switched between anteromedial and low medial one.

Results: With the use of this portal the average surgical time was observed to be 43 minutes and no malpositioning of tunnel was encountered.

Conclusions: This switching portal technique provides an excellent view of the femoral tunnel plot and gives consistent results with minimum complications.


Keywords


Switching portal, Residents ridge, Working portal

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References


Ahn JH, Jeong HJ, Ko CS, Ko TS, Kim JH. Three-dimensional reconstruction computed tomography evaluation of tunnel location during single-bundle anterior cruciate ligament reconstruction: A comparison of transtibial and 2-incision tibial tunnel-independent techniques. Clin Orthop Surg. 2013;5:26–35.

Morgan JA, Dahm D, Levy B, Stuart MJ, MARS Study Group. Femoral tunnel malposition in ACL revision reconstruction. J Knee Surg. 2012;25:361–8.

MARS Group, Wright RW, Huston LJ. Descriptive epidemiology of the Multicenter ACL Revision Study (MARS) cohort. Am J Sports Med. 2010;38:1979–86.

Kopf S, Pombo MW, Shen W, Irrgang JJ, Fu FH. The ability of 3 different approaches to restore the anatomic anteromedial bundle femoral insertion site during anatomic anterior cruciate ligament reconstruction. Arthroscopy. 2011;27:200–6.

Tashiro Y, Okazaki K, Uemura M. Comparison of transtibial and transportal techniques in drilling femoral tunnels during anterior cruciate ligament reconstruction using 3D-CAD models. Open Access J Sports Med. 2014;5:65–72.

Tompkins M, Milewski MD, Brockmeier SF, Gaskin CM, Hart JM, et al. Anatomic femoral tunnel drilling in anterior cruciate ligament reconstruction:Use of an accessory medial portal versus traditional transtibial drilling. Am J Sports Med. 2012;40:1313–21.

Ferretti M, Ekdahl M, Shen W, Fu FH. Osseous landmarks of the femoral attachment of the anterior cruciate ligament:An anatomic study. Arthroscopy. 2007;23:1218–25.

Xu H, Zhang C, Zhang, Q. A systematic review of anterior cruciate ligament femoral footprint location evaluated by quadrant method for single-bundle and double-bundle anatomic reconstruction. Arthroscopy. 2016;32:1724–34.

Farrow LD, Chen MR, Cooperman D.R, Victoroff BN, Goodfellow DB. Morphology of the femoral intercondylar notch. J Bone Joint Surg Am. 2007;89:2150–5.

Piefer JW, Pflugner TR, Hwang MD, Lubowitz JH. Anterior cruciate ligament femoral footprint anatomy:Systematic review of the 21st century literature. Arthroscopy. 2012;28:872–81.

Lubowitz JH. Anteromedial portal technique for the anterior cruciate ligament femoral socket:pitfalls and solutions. Arthroscopy. 2009;25(1):95-101.

Bedi A, Altchek DW. The “Footprint” anterior cruciate ligament technique:an anatomic approach to anterior cruciate ligament reconstruction. Arthroscopy 2009;25:1128–1.


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