Ricostruzione endoscopica del legamento crociato anteriore con innesto dal tendine quadricipitale e fissazione rigida: tecnica chirurgica

We present a new technique for the anterior cruciate ligament reconstruction, using a graft from the quadriceps tendon, in order to avoid the most common complications related to the use of the middle third of the patellar tendon or the hamstring grafts. The quadriceps tendon graft has biomechanical characteristics which are similar to those of the patellar tendon and of the hamstring grafts, thus allowing an ideal fixation on the bony end. There still are many doubts concerning the free end fixation, just as happens with the hamstring graft. Since 2000, a new method of femoral fixation has been available. This method uses two bioabsorbable pins (Rigid-Fix, Mitek, Ethicon, Westwood, Massachusetts, U.S.A.), for both the bone blocks and the soft-tissue ends. We describe the technique for the use of the quadricep's tendon graft with the soft end fixed to the femur by the Rigid-Fix system. The advantages of this technique are: reduced problems at the donor site, a cross sectional area 1.8 bigger than the patellar tendon graft, the transcondylar bioabsorbable fixation that gives the possibility to obtain a growth of the fibres by inserting the nails through the fibres of the graft, with a following enlargement of the tendon-bone contact area at reaming level. This technique, moreover, avoids the risk of secondary effects such as the windshield wiper effect and the bungee effect, caused by the unsatisfactory tibial fixation of the soft tissues. The use of the quadriceps tendon pro-ACL in the primary reconstruction, as a standard, is advisable in case of pre-operative pain in the anterior area, or when the patient does a working or sporting activity in a genuflected position.