Surgical techniqueSurgical technique

Harvest the Semitendinosus and Gracilis Harvest the Semitendinosus and Gracilis tendonstendons

Whipstitch graft Whipstitch graft ends with #2ends with #2 Ethibond (2 cm)Ethibond (2 cm)

Surgical techniqueSurgical technique

Surgical techniqueSurgical techniqueSoft Tissue and Bone Tendon Soft Tissue and Bone Tendon BoneBone

Tibial Tibial tunnel tunnel

Femoral half Femoral half tunnel: 25-30 mm tunnel: 25-30 mm depth depth

Drill tibial guide pin Drill tibial guide pin at 40-50at 40-50oo

Typically 35-45mm Typically 35-45mm longlong..

Surgical techniqueSurgical technique

Drill or dilate Drill or dilate tunneltunnel

Surgical techniqueSurgical technique

Insert the guide Insert the guide (attached to the (attached to the appropriate size appropriate size femoral rod) into femoral rod) into the femoral tunnel the femoral tunnel until it touches until it touches the endthe end

Surgical techniqueSurgical technique

Surgical techniqueSurgical techniqueDrill the Drill the sleeve-sleeve-trocar trocar assembly assembly through the through the two holes of two holes of the guide the guide into the into the lateral side lateral side of the femurof the femur

Surgical techniqueSurgical technique

Remove the Remove the guide frame guide frame from the from the knee, leaving knee, leaving only the two only the two sleeves sleeves in the in the lateral aspect lateral aspect of the femur.of the femur.

Surgical techniqueSurgical technique

Pull the graft Pull the graft into the into the tunnel using tunnel using a guide wirea guide wire

Surgical techniqueSurgical technique

Insert the RIGIDfix Insert the RIGIDfix cross pins into the cross pins into the sleeves using the sleeves using the stepped pin insertion stepped pin insertion rod and mallet.rod and mallet.

Surgical techniqueSurgical technique

Remove the Remove the sleeves.sleeves.The graft is now The graft is now fixed in the fixed in the femoral tunnel femoral tunnel by two parallel by two parallel absorbable pins.absorbable pins.

Pull the graft in Pull the graft in positionposition

Knot sutures in two Knot sutures in two loops (ST ends loops (ST ends together and GR together and GR ends together)ends together)..

Knot Knot 10-12 cm10-12 cm from from tibial tunnel edgetibial tunnel edge..

12 cm

Surgical techniqueSurgical technique

TechniqueTechnique

•Pass the graft Pass the graft

endoscopicallyendoscopically

•BTB blocks to face BTB blocks to face

anterior, tissue anterior, tissue

posteriorposterior..

BTB GraftBTB Graft

Femoral Femoral BTB BTB fixationfixation::•Insert Insert aa GW through GW through

anteromedial portal or anteromedial portal or PT defectPT defect..

•Notch tunnel over GWNotch tunnel over GW..•Hyperflex knee, insert Hyperflex knee, insert

screwscrew..

TechniqueTechnique

BTB fixationBTB fixationTranscondylar screw or pinsTranscondylar screw or pins

Tibial Tibial BTB BTB fixationfixation::•Tension graft Tension graft

distallydistally..•Insert GW on Insert GW on

superior surface superior surface of graftof graft..

•Insert screwInsert screw..

TechniqueTechnique

7 m

m3

.3 m

m

10

.3 m

m

7 mm 7 mm

10

.3 m

m

3.3

mm

In the ST technique:In the ST technique:there is “press-fit” not “hanging on”!there is “press-fit” not “hanging on”!

Orientation Orientation teststests

The ST tendons are whipstitched at the looped The ST tendons are whipstitched at the looped end, forming a tight bundle that is “press-fit” end, forming a tight bundle that is “press-fit” placed into the femoral tunnel. This allows placed into the femoral tunnel. This allows RIGIDfix absorbable pins to cross the graft in RIGIDfix absorbable pins to cross the graft in any plane and provide rigid fixation.any plane and provide rigid fixation.