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Chap. 15 Video 2: Revision Single Bundle ACL Reconstruction Using BPTB Autograft pt 1

February 05, 2016

Contributors: Bernard R Bach Jr, MD

This video demonstrates the first part of two for a revision single bundle ACL reconstruction using a transfibular endoscopic technique with a bone-tendon-bone autograft for a 19 year old female athlete. An examination under anesthesia reveals a grade two pivot shift, and the importance of checking for medial or lateral side instability is discussed. The graft is harvested through an incision along the medial edge of the patellar tendon. The tibial bone plug is cut first, and the soft tissue is left attached to the infrapatellar fat pad for stability while cutting the patellar plug. Diagnostic arthroscopy is carried out through a standard infralateral portal through the wound incision, which allows for better visualization. A medial portal is made adjacent to the patellar tendon at the level of the patella. The remnants of the ACL are removed with arthroscopic scissors, and a posterior notchplasty is performed with a spherical burr. An accessory inframedial portal is made with a spinal needle, which aids in distalization of the insertion on the tibial entrance site, as well as allowing for a more oblique orientation with the tibial tunnel. An aiming device is inserted through the transpatellar portal.

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