Summary

This abstract considers our experience in BTB flipped autograft preparation technique with suspensory device and adjustability in bone sockets after final preparation

Abstract

Introduction

All inside BTB flipped graft reconstruction technique of the ACL enables the application of BTB graft in properly selected patients while sparing the outer cortex for fixation via the endobutton TightRope system. For this purpose advantages of using TightRope RT are based on one universal implant size and adjustible loop with a negligibly low fixation failure rate.

Objective

The objective of this presentation is possibility of using this type proper match BTB flipped graft in our several cases with the advantages of direct bony ingrowth in All inside reconstruction ACL instead of the standard technique which was originaly described by Lubowitz et al by using an autograft HT GraftLink.

Material/results: The recommended lenght of the graft is 65mm to 70mm which is achieved by folding the bone block in full length taken from the patella onto the ligament around the loop of the TightRope RT implant and fixation with resorbable sutures, thus avoiding the previous mismatch between the entire length of the graft and all inside femoral and tibial bone sockets. In this way, the bone tissue of the donor site is spare since a thinner bone block taken from the patella in needed, which also potentially contributes to reducing the intensity of postoperative anterior knee pain. Placement of the femoral and tibial sockets, our recommended length of 255mm and proper guide angle with a flipcutter ensures maximum adaptability of the graft and its satisfactory tensioning within the joint in all previously operated patients.

Conclusion

The use of BTB and TightRope RT allows for anatomical graft placement without the use of traditional interference screws while the adjustability of the implant loop and locking system ensures reliable cortical fixation. Preparation of the BTB flipped autograft avoids a potential intraoperative mismatch between its length and the length of bone sockets with joint space as it was described in original previous technique.

Key words: All inside ACL, BTB flipped graft, length mismatch