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PDF | The technique for endobutton femoral fixation of double semitendinosus/ double gracilis hamstring anterior cruciate ligament (ACL). Find out all of the information about the Smith & Nephew product: ACL reconstruction suture button ENDOBUTTON. Contact a supplier or the parent company. ACL reconstruction performed using a transtibial tunnel technique often .. to be inserted into the ACL femoral socket when using a 15 mm ENDOBUTTON CL.

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ACL reconstruction suture button – ENDOBUTTON – Smith & Nephew

Tendon-healing in a bone tunnel: The laxity during cyclic loading and the displacement to failure during single-cycle test were lower for the Bio Cross-Pin fixation 8. The groups were treated through fixation procedures either Endobutton or Rigidfix. When the failure did not occur in the Endotape, the displacement-load curve showed a different pattern. Seating of TightRope RT button under direct arthroscopic visualization in anterior cruciate ligament reconstruction to prevent potential complications.

Failure during cyclical loading was assumed to occur in cases in which a complete slippage of the fixation device was observed. Dilate the AAM portal by inserting the tips of the Metzenbaum scissors or a small curved clamp into the incision and spreading the tips in-line with the direction of the portal.

Comparison of 2 femoral tunnel locations in anatomic single-bundle anterior cruciate ligament reconstruction: Keeping the tip of the 2. Furthermore, the slippage impairs the integration and ligamentization process Rodeo et al. This can result in bleeding and a loss of joint visualisation due to encroachment of the fat pad into the notch.

Current concepts current trends in anterior cruciate ligament peconstruction – Part 1: The yield load has been advocated as the most important variable to be evaluated in the performance of fixation Kousa et al. Unlike the transtibial technique where the ACL femoral and tibial bone tunnels are collinear, drilling the ACL femoral tunnel through a medial portal results in divergence of the two tunnels.

Femoral fixation solution for ACL reconstruction | Smith & Nephew – Corporate

Bone tunnel enlargement after anterior cruciate ligament reconstruction with semitendinosus tendon tehnique Endobutton fixation on the femoral side. In this situation, it may be advantageous to insert endobuttom ruler through the AAM.


The centre of the ACL femoral attachment site in the high-low direction is located halfway between these two landmarks Fig. Graft insertion into the tibial and femoral tunnels Use an arthroscopic probe or grasper to retrieve the suture loop that was left in the ACL femoral tunnel and pull the suture out of the knee joint through the tibial tunnel.

Proper placement of the AAM portal is also critical to the success of the procedure, as it is the most important factor affecting the length of the ACL femoral tunnel. These steps allow a tibial tunnel of a known length to be drilled, thus allowing the issue of graft-tunnel length mismatch to be addressed. The most common error made when converting from the transtibial tunnel technique to the AM portal technique is to position the tibial guide pin in the posterior half of the ACL tibial attachment site.

The diameter of Cross-Pin is higher than Endotape, increasing the volume when the tendon loops. Open in a separate window.

Assessment of the hamstring autograft femoral fixation using the EndoButton CL. Biomechanical studies have shown that a vertically oriented ACL graft may resist the motion of anterior tibial translation, but may fail to control the combined motions of anterior tibial translation and internal endobhtton rotation which occur during the pivot-shift phenomenon [ 3 — 6 ].

The medial joint line is marked by the dotted white line. Due to the large degree of variability of the intercondylar notch roof angle and the amount of knee hyperextension from patient to patient, it is extremely helpful to use fluoroscopy to confirm correct anterior-posterior placement of the ACL tibial guide pin.

Note that in this particular case, the centre of the ACL femoral attachment site lies slightly deep proximal to the lateral bifurcate ridge. EndoButton is an extra-articular device made of metallic button and a polyurethane ribbon Endotape.

ACL Technique: Endoscopic Hamstring Graft with Endobutton

The view of the intercondylar notch and the ACL femoral attachment site changes significantly depending on the arthroscopic portal used. Accelerated rehabilitation after anterior cruciate ligament reconstruction.


Endobutton and Tfchnique are most frequent treating methods that used by orthopedic surgeons. Previous studies have shown that ligament loads of this magnitude can be generated during quadriceps muscle contraction at full knee extension Rupp et al. After this, a 30 mm tunnel was drilled with a 9 mm diameter for the graft positioning.

Suture button—based femoral cortical suspension constructs of anterior cruciate ligament grafts can facilitate a fast and secure fixation. Anatomical studies have demonstrated that the ACL femoral attachment site is defined by two osseous ridges [ 9 ].

Table 1 Correct angle of knee flexion for tensioning of the ACL graft for different femoral tunnel positions. Similar to any surgical technique, there is a learning curve to the medial portal technique for ACL reconstruction. Iliotibial band irritation caused by the EndoButton after anatomic double-bundle anterior cruciate ligament reconstruction: The principle of EndoButton is based on the cortical suspension of the graft.

ACL femoral tunnel placement endobuttob more accurately defined and specified using the following methods:. This paper describes the advantages of the medial portal technique, indications for the technique, patient positioning, proper portal placement, anatomical femoral and tibial tunnel scl, graft tensioning and fixation. Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions.

Results No fixation devices failed during the cyclic loading test. If a three-portal technique has been used, fluid flow and visualisation in the notch with the knee in hyperflexion can be facilitated by introducing a motorised shaver blade through the AL portal.

A standardized postoperative protocol is implemented for each patient. Closure Finally the knee stability is tested and all wounds are closed. Adjust the position of the portal accordingly.