Press-Fit Fixation of the Knee Ligaments

Description

This book describes all aspects of a purely biological approach to knee ligament reconstruction that entirely avoids the use of foreign materials in a manner analogous to the use of dowels in carpentry. The technique, referred to as “all-press-fit reconstruction”, was developed by the author in 1995 for anterior cruciate ligament (ACL) reconstruction and has since been further developed so that it is now applicable to all knee ligaments and also osteochondral autologous transplantation surgery. It has the advantages of maintenance of individual biological resources (no bone loss), rapid rehabilitation, and excellent clinical outcomes in terms of stability and anchoring. This book explores subtle clinical and technical diagnostics and provides step-by-step descriptions of the various surgical techniques used by the author. Readers will also learn about the history of ACL reconstruction and the results achieved to date, sources of graft for ACL replacement, the surgical instrumentation required for press-fit fixation, the healing response, and procedures for revision of re-rupture. In addition, rehabilitation and prevention programs are fully described for every level of athletic activity.  Foreword 1 Foreword 2 Foreword 3 Foreword 4 Foreword 5 Preface Acknowledgements Contents 1: Anatomy and Biomechanics 1.1 Anterior Crucial Ligament 1.2 Biomechanics 1.3 Anterior Tibial Translation 1.4 Stability in Rotation 1.5 Posterior Cruciate Ligament 1.5.1 Anatomy 1.5.2 Biomechanics 1.6 Medial Collateral Structures 1.6.1 Anatomy 1.6.1.1 Superficial Medial Collateral Ligament 1.6.1.2 Deep Medial Collateral Ligament 1.6.1.3 Posterior Oblique Ligament 1.6.2 Biomechanics 1.7 Lateral Collateral Structures 1.7.1 Anatomy 1.7.2 Biomechanics References 2: Overuse: Trauma and Mechanism—Knee Morphology Risk Factors 2.1 Anterior Cruciate Ligament 2.2 Medial Collateral Ligament 2.3 Posterior Cruciate Ligament 2.4 Lateral Collateral Ligament References 3: Diagnostics and Treatment 3.1 Anterior Cruciate Ligament 3.2 Posterior Cruciate Ligament 3.3 Collateral Ligaments (Medial and Lateral) References 4: History of ACL Reconstruction References 5: History and Techniques of Material-Free and Press-Fit ACL Reconstruction 5.1 Introduction 5.2 History and Surgical Techniques of Foreign Material-Free ACL Reconstruction 5.3 History of All Press-Fit 5.4 “Against the Wind”: How to Establish a Scientific Working Group for Foreign Material-Free ACL Replacement 5.5 Stability of Fixation 5.6 Techniques for All Press-Fit 5.6.1 Patellar BTB 5.6.2 Hamstring 5.6.3 Quadriceps Tendon 5.6.4 Revision 5.6.5 Other Ligaments Reconstruction 5.7 Clinical Outcome 5.8 What We Learned 5.9 Conclusion References 6: ACL All Press-Fit: A Surgical Guide Step by Step 6.1 Hamstring “All Press-Fit” Fixation with Bone Dowels 6.1.1 Indications 6.1.2 Preoperative Assessment 6.1.2.1 Clinical Assessment Basic Signs of ACL Tear Further Physical Assessment 6.1.2.2 Imaging Assessment Radiographs, Computed Tomography (CT), Digital Volume Tomography (DVT) Magnetic Resonance Imaging (MRI) 6.1.3 Timing of Surgery 6.1.4 Surgical Preparation 6.1.4.1 Surgical Equipment 6.1.4.2 Equipment Positioning 6.1.4.3 Patient Positioning 6.1.4.4 Further Preparation 6.1.4.5 Arthroscopic Cleaning Portals Remove the ACL Stump and Leave a Smal Rest at the Tibial Insertion 6.1.5 Surgical Technique 6.1.5.1 Harvesting Hamstring Graft 6.1.5.2 Performing Tunnels Femoral Tunnel Tibial Tunnel 6.1.5.3 Prepare the Graft 6.1.5.4 Passage of the Graft 6.1.5.5 Fixation and Tensioning of the Graft Tibial Fixation Femoral Fixation 6.1.5.6 Reverse to the Established Procedure: “Bottom-to-Top” Fixation Is a “Self-Adapted Tensioning” Based on the Geometry of the Knee 6.1.5.7 Possible Peri-operative Complications 6.1.5.8 Closure 6.1.5.9 Postoperative Course 6.1.5.10 Early-Phase Postoperative Complications 6.2 Quadriceps Tendon-Bone or BTB Fixation with Bone Dowels “All Press-Fit” 6.2.1 Surgical Preparation 6.2.1.1 Surgical Equipment 6.2.2 Surgical Technique 6.2.2.1 Harvesting Tendon-Bone Graft 6.2.2.2 Graft with Patellar Bone Cylinder (A) or Without (B) 6.2.2.3 Performing Tunnels 6.2.2.4 Prepare the Graft 6.2.2.5 Passage of the Graft For BTB Graft 6.2.2.6 Fixation of the Graft Tibial Fixation Femoral Fixation 6.2.2.7 Possible Peri-operative Complications 6.2.2.8 Closure 6.2.2.9 Post-operative Course 6.3 ACL Reconstruction with Patella BTB or TB with Bone Dowels “All Press-Fit” 6.3.1 Surgical Preparation 6.3.1.1 Surgical Equipment 6.3.2 Surgical Technique 6.3.2.1 Harvesting Bone-Tendon-Bone Graft 6.3.2.2 Performing Tunnels Femoral Tunnel Tibial Tunnel 6.3.2.3 Passage of the Graft 6.3.2.4 Fixation of the Graft Tibial Fixation Femoral Fixation 6.3.2.5 Possible Peri-operative Complications 6.3.2.6 Closure 6.3.2.7 Postoperative Course 6.3.2.8 Early-Phase Postoperative Complications References 7: Healing Response of the ACL with Bone Incision 7.1 When to Apply Surgery and Healing Response? 7.2 Surgical Technique 7.3 Rehabilitation 7.4 Our Own Results 7.5 Healing Response in the Posterior Cruciate Ligament 7.6 Diagnostics 7.6.1 Clinical Examination 7.7 Indication 7.8 Technique and surgery 7.9 Rehabilitation 7.10 Results 7.11 Conclusion References 8: ACL Revision After Re-Rupture 8.1 Diagnostics 8.2 Surgical Management and Planning 8.3 How to Make Decision 8.3.1 Single-Stage Revision 8.4 Rehabilitation 8.4.1 Two-Stage Revision References 9: Repair of Cartilage Defects with Mosaicplasty: Osteochondral Autograft Transfer 9.1 Indications 9.2 Pre-operative Assessment 9.2.1 Clinical Assessment 9.2.2 Imaging Assessment 9.2.2.1 Radiographs 9.2.2.2 Magnetic Resonance Imaging (MRI) 9.2.2.3 Timing of Surgery 9.3 Surgical Preparation 9.3.1 Surgical Equipment 9.3.1.1 Drill with Jacobs Connector 9.4 Surgical Technique 9.4.1 Arthroscopy 9.4.1.1 Portals 9.4.2 Transfer of Osteochondral Bone 9.4.2.1 Resurface the Lesion 9.4.2.2 Fill the Donor Site 9.4.2.3 Individual Variations 9.4.2.4 Possible Peri-operative Complications 9.4.3 Closure References 10: Management of Quality and Complications 10.1 Preoperative Planning 10.2 Tendon Removal 10.3 Tunnel Position 10.4 Graft Insertion and Fixation 10.5 Postoperative Infection 10.6 Quality Control and Benchmarks References 11: Rehabilitation After ACL Reconstruction, Return to Sport and Prevention 11.1 Biomechanics of the Anterior Cruciate Ligament and Conclusion for Rehabilitation Exercises 11.2 Biology and Physiology 11.3 Rehabilitation 11.3.1 Guidelines for ACL-Reconstruction After All Press-Fit Programs A and B 11.3.2 First Postoperative Days 11.3.2.1 Heal Slides 11.3.2.2 Weight Shifting 11.3.2.3 Quadriceps Contraction 11.3.3 Postoperative Days 3–7 11.3.3.1 Mini Squats 11.3.4 Second Postoperative Week 11.3.4.1 Single-Legged Squats 11.3.4.2 Core Training 11.3.4.3 Stability Training 11.3.4.4 Cycling 11.3.5 Three to Four Weeks: Dynamic Lunges 11.3.6 Five to Eight Weeks: Jump Trainings 11.3.7 Six to Eight Weeks: Running Technique 11.3.8 Three Months: Sprint-Training 11.3.9 Four Months: Cutting Movements 11.3.10 Five Months: Jogging 11.3.11 Five to Six Months: Sport-Specific Drills 11.3.12 Return to Play 11.4 Prevention 11.4.1 Effects of Prevention Programs 11.4.2 Example: Basic Structure of a Prevention Warm-Up Program References