AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-ACL Reconstruction Hamstring Autograft_ Harvest and Fixation-Catherine Hui, M.D.

ACL Reconstruction Hamstring Autograft_ Harvest and Fixation-Catherine Hui, M.D.

Pdf Summary

This presentation by Dr. Catherine Hui outlines key aspects of anterior cruciate ligament (ACL) reconstruction using hamstring autograft. Pre-operative planning is emphasized as critical for successful outcomes, focusing on thorough history, clinical exam, imaging, and identifying meniscal or ligamentous injuries. Equipment considerations include arthroscopic scopes and graft options.<br /><br />A major topic is graft selection, particularly the benefits of the hamstring autograft over other graft types like bone-patellar tendon-bone (BTB), quadriceps tendon, and allograft. Advantages cited include more cosmetically appealing scars.<br /><br />Surgical setup involves positioning the knee at 70º flexion with appropriate supports. Incision placement is crucial, starting medial and distal to the tibial tubercle over the pes anserinus. During hamstring tendon harvest, particular attention is given to identifying and sparing the gracilis and semitendinosus tendons, avoiding the sartorius and extra bands, and using a smooth technique for stripper passage to prevent stump formation.<br /><br />Graft preparation includes trimming to achieve symmetrical diameter and proper length (60-75mm), typically aiming for 8.0-10.0mm diameter. Adjustable cortical button fixation is used on the femur, and an adjustable implant on the tibia.<br /><br />The surgical technique involves diagnostic arthroscopy, treatment of meniscal/cartilage injuries, femoral tunnel preparation via the anteromedial portal, tibial tunnel drilling, graft passage, and secure fixation with tensioning under direct visualization.<br /><br />Common intraoperative challenges such as inadequate graft length, tunnel misplacement, or implant capture are addressed with practical strategies including use of additional tendons, creation of a second portal, rescue implants, or alternate fixation methods.<br /><br />Overall, the presentation emphasizes meticulous planning, surgical precision, and flexibility to manage complications for successful ACL reconstruction using hamstring autograft.

Keywords

ACL reconstruction

hamstring autograft

pre-operative planning

graft selection

surgical setup

hamstring tendon harvest

graft preparation

arthroscopic technique

tunnel drilling

intraoperative challenges