Cruciate ligament reconstruction - surgical technique and graft

Our selection of surgical technique and tendon graft for cruciate ligament reconstruction. Cruciate ligament reconstruction is the most frequently performed ligament plastic surgery. The choice of surgical technique and graft is based on the specific properties of the graft and the location of the tear, the sporting and sport-specific requirements of the recipient, the concomitant injuries in a cruciate ligament rupture and also the anatomical conditions of the patient.

The so-called autologous transplants (autologous in medical parlance means belonging to the same individual) primarily include:

Semitendinosus/Gracilis tendon (STG)
Patellar tendon (PS)
Quadriceps tendon (QS)
Allograft (AG)

In North America, so-called allogeneic transplants (meaning originating elsewhere or transferred from another individual of the same species - for example, from another human being) are used far more frequently than in Europe. However, essential graft requirements should be met in order to achieve an optimal postoperative result.

Important properties of the graft

Biomechanical properties of the graft should be comparable to the former own.
Good healing rates of the graft so that early stability allows rapid recovery of activity levels.
lasting knee stability.
low removal problem of the replacement tendon

Which surgical technique and which transplant for which patient?

The table below gives an overview of the current status of the various surgical techniques (e.g. cruciate ligament preservation surgery) and graft selection for reconstruction as we use them for specific patients:

Semitendinosus/Gracilis

Isolated complete cruciate ligament rupture: Reconstruction: with semitendinosus tendon (single-bundle technique) or supply with semitendinosus and gracilis tendon (two-bundle technique) of the injured side.

Isolated anterior cruciate ligament r upture (Sherman type I and II): Repair technique: Anterior cruciate ligament rupture near the thigh (Sherman type I and II)

Partial cruciate ligament rupture with preserved residual cruciate ligament: Reconstruction and repair technique: semitendinosus or gracilis tendon (replacement of the anteromedial or posterolateral bundle) with preservation of the residual cruciate ligament.

Partial cruciate l igamentrupture with little remaining cruciate ligament: Reconstruction- repair technique and ligament bracing: semitendinosus or gracilis tendon (replacement of the anteromedial or posterolateral bundle) with preservation of the remaining cruciate ligament and reinforcement ligament (fibre tape)

Cruciate ligament rupture and medial ligament: In 2nd-3rd degree medial ligament injuries or detachments of the meniscus suspension of the medial meniscus: semitendinosus tendon of the uninjured side or quadriceps tendon of the injured side with meniscus suture technique and or open medial shirring of the posterior oblique ligament with or without medial ligament repair. For chronic older medial ligament injuries, we recommend reconstruction with semitendinosus tendon.

Cruciate ligament rupture and knock knees: reconstruction: semitendinosus tendon of the uninjured side or quadriceps tendon of the injured side

Cruciate ligament rupture and axial defect: In the case of leg axis deviations, e.g. rotation defect with knock-kneed position: Reconstruction possibly semitendinosus tendon of the opposite side - or quadriceps tendon of the injured side.

Cruciate ligament rupture and patella : For patella disorders: Reconstruction of the semitendinosus tendon of the injured leg, no patella or quadriceps tendon.

Cruciate ligament rupture and growth: In case of open growth plates: semitendinosus tendon of the injured leg in the all inside technique

Quadriceps tendon

Isolated cruciate ligament rupture: quadriceps tendon sport-specific : e.g. judoka and dancer, football and ice hockey player

Cruciate ligament rupture: in patients with a high risk of rupture

Cruciate ligament rupture and inner ligament: in the case of congenital clear X-B adjustment, inner ligament instabilities (3rd degree) and axial rotation defect

Cruciate ligamentrevision: for replasty of the cruciate ligament

Patellar tendon

Isolated cruciate ligament rupture: not suitable as primary graft: considerable problems with harvesting the bone blocks (knee pain syndrome!), therefore only when all other graft options have been exhausted.
As primary graft: semitendinosus or quadriceps.

Cruciate ligament revision: not suitable as primary graft: considerable problems with removal of bone blocks (knee pain syndrome!), therefore only when all other graft options have been exhausted.
As primary graft: semitendinosus or quadriceps

Allograft

Isolated cruciate ligament rupture: suitable as primary graft: at patient's request

Cruciate ligament revision: suitable as a graft: if no autologous grafts are available

Cruciate ligament rupture and extra-articular stabilisation: suitable as a graft: e.g. for anterolateral or posterolateral stabilisation etc.

What practical consequences can we derive from this?

Graft selection should be patient-specific
The surgeon should be proficient in all common transplantation techniques
The cruciate ligament preserving surgical technique should be an option in case of cracks close to the thighs