- Technique:
- at this point, No 2 Ethibond stay sutures will have already been passed thru drill holes made in each bone plug;
- proposed tibial bone plug should have an additional stay suture passed thru the bone-tendon interval
(as a safety feature should the interference screws cut through the bone plug stay sutures);
- prior to graft passage mark each graft ends w/ a skin marker:
- mark the proximal osseous tendinous junction is marked;
- mark the cortical surface of the distal end of the proposed tibial graft;
- shut off inflow as saline will cause the graft to expand;
- prior to graft passage, use a pituitary grabber to remove soft tissue surrounding
the outer femoral tunnel (to facilitate graft passage);
- the smaller of the bone plugs will enter the tunnel first;
- ensure that the cortical side of the proximal bone plug faces posteriorly;
- the cortical surface of the distal (tibial) bone plug may either face anterior or posteriorly,
depending on whether the tibial tunnel has been placed too anteriorly or too posteriorly;
- if unsure, the cortical surface should face posteriorly;
-
one incision technique:
- previously a Harris Beath guide wire has been passed thru the femoral tunnel site, which
subsequently has been driven out of the skin on the anterolateral aspect of the thigh;
- one or two No 2 ethibond sutures are passsed thru drill holes at one end of the graft,
which are then passed thru the "eye" of the distal end of the guide wire;
- the proximal end of the guide wire is then pulled proximally, drawing the graft into
the tibial and femoral tunnels;
-
two incision technique:
- pass the tibial bone plug stay sutures down the femoral tunnel and into the intercondylar notch;
- pass a grabber up the tibial tunnel and grab the stay sutures, pulling the sutures out of the tibial tunnel;
- this is visualized under air arthroscopy;
- a probed placed thru
anteromedial portal assists w/ passage;
- plugs are visualized at each end;
- look for the blue mark at the edge of the bone plug to ensure that the entire plug resides with in the tunnel;
- the distal bone plug can be rotated 90 deg laterally;
