In addition to patellar tendon as a bone-tendon-bone transplant, the semitendinosus and the gracilis tendons have become established as the gold standard for anterior cruciate ligament reconstruction. Utilising the semitendinosus and gracilis tendons has the advantage of a minimal incision of just 2 cm, allowing dissection of the tendons at the pes anserinus. Fixation of the autologous graft is usually done by using screws and/or small plates, and is executed at a finite distance from the joint.
A well known disadvantage of this, is the bungee effect which occurs when the graft bunches and contracts during flexion and again during bending and stretching movements. Tibial tunnel dilation (the windscreen wiper effect) of the tibia channel significantly increases the bungee effect. Insufficient stability and bone loss can result. Especially for revision surgeries the necessity for bone grafting occurs, in order to fill up the defects before a revision graft placement can be done. In addition, screws and other fixing material have to be removed and often bone defects are incurred as a result. Occasionally removal of such instrumentation can result in severe problems and potentially significant bone loss. Furthermore the use of conventional trephine drills are significantly more traumatic, than the smooth cutting achieved with a diamond core reamer. This has been proven utilising MRT, in a large number of cases. To solve this problem, the transplant has to be fixed near the joint with the anatomic reconstruction being carried out without the use of foreign material.
With the ALL-PRESS-FIT replacement for the cruciate ligament according to Felmet, a foreign material free method has been developed that enables a solid Press-Fit anchoring of the free tendon transplant onto the tibia and the femur near to the joint. All the problems recognised so far have been completely solved by this method. This method was made possible by using the Arthrosurge® DATS®-Instruments (Diamond ACL Transplantation System).
Well matched diamond core reamers guarantee a Press-Fit anchoring of bone cylinders within the implantation channels, with the help of the wet grinding method. Especially developed target devices for use in conjunction with the diamond core reamers at the tibia and the femur, allow for a precise positioning of the implantation channels.
With the help of the pioneering development of the BTT ® (BOTTOM TO TOP) implantation method, it is now possible for the first time to tension the transplant intra-articularly by fixing it close to the joint during knee flexion. By moving the knee joint into extension, the replacement for the cruciate ligament gains its final tension with the help of the geometry of the joint. The implantation channels and the resulting defects will be completely impacted with the remaining bone cylinders. The ALL-PRESS-FIT cruciate ligament reconstruction using the semitendinosus and the gracilis tendons with the BTT implantation method, has been clinically proven to give outstanding results in hundreds of interventions over the last 15 years. On a similar basis the Double-Bundle-Single-Channel technique has been developed. This technique makes it possible to get closer to anatomically correct femoral and tibial insertion sites, with the use of different bone core reamer diameters. This technique has been described separately.
After three to four weeks, bone cylinders fixed with Press-Fit anchoring are well fixed with bone on bone integration, as has been proven by Draenert and Gerber Since 1993. Thus demonstrating more than 15 years excellent results with the ALL-PRESS-FIT anterior cruciate ligament reconstruction, with patellar tendons. Since 2003 the BTT cruciate ligament reconstruction with a free tendon transplant developed, using the semitendinosus and the gracilis tendons. Also offering a biological, cost effective and very stable method.
The advantages of the BTT crucial ligament replacement:
• Autologous, totally biological replacement
• Free of foreign material, for a quick and natural healing of bones and ligaments
• Anatomical press fit, due to close joint proximity
• Independent BTT fixation, and transplant tensioning
• Strong pull-out forces required, due to champagne cork rule
• Immediate stability exhibited, for early exercise
• No bony defects resulting
• No artefacts on X-ray or MRI
DATS® Instruments have the following advantages:
• Diamond core reamers ensure a high accuracy, in following the Press-Fit standard
• Can be extended for using patellar tendon or quadriceps tendon, as a replacement for the cruciate ligament
• Gentle atraumatic grinding of cylinders, instead of traumatic drilling
• Accurate targetting devices
DATS, BTT and Arthrosurge are trademarks of Articomed. DANNEWITZ GmbH & Co is not affiliated with Articomed.
