APEX Optimizing Surgical Outcomes for Knee & Shoulder Arthroscopy-Optimizing ACLR: Notchplasty, Tunnel Placement, Graft Passage

Video Transcription

Video Summary

Cesario Trueva's presentation on optimizing anterior cruciate ligament (ACL) reconstruction highlights the critical factors influencing surgical success. Key points include graft selection—quadriceps, patellar tendon, or hamstrings—with studies showing graft type affects revision rates but is not the sole determinant of outcome. Fixation methods vary, with suspension devices and screws differing in failure tension. Extra-articular tenodesis and graft augmentation techniques yield comparable stability and return-to-sport rates. The femoral tunnel's anatomical placement emerges as the most decisive factor in success, with malposition causing nearly half of graft failures. Accurate tunnel positioning requires understanding ACL anatomy—anteromedial and posterolateral bands—and precise surgical landmarks. Techniques include transtibial, medial portal, and retroconstruction; each has pros and cons regarding anatomy reproduction, tunnel length, and risk of complications. Trueva advocates a retroconstruction approach using a flip cutter for reproducible, anatomical tunnels. Overall, millimeter-level precision in femoral tunnel placement is essential, as minor errors significantly increase failure rates, underscoring anatomy's paramount role in ACL reconstruction outcomes.

Asset Caption

Faculty: Cesareo T. Vasavilbaso, M.D.

Keywords

ACL reconstruction

femoral tunnel placement

graft selection

surgical techniques

anatomical landmarks