Mini-incision Patellar Tendon Harvest and Anterior Cruciate Ligament Reconstruction Using Critical Bony Landmarks
Orthopaedic Associates of Aspen and Glenwood, 100 E. Main St., Aspen, CO 81611, USA.Sports medicine and arthroscopy review (Impact Factor: 1.68). 12/2009; 17(4):234-41. DOI: 10.1097/JSA.0b013e3181c14760
Graft choice remains an area of contention in anterior cruciate ligament reconstruction. Poorer cosmetic results and anterior knee pain remain a problem in the use of autologous patellar tendon grafts despite excellent clinical results when compared with autologous hamstring tendon grafts. Using a 2-incision technique to harvest the patellar tendon grafts has been shown to decrease the risk of anterior knee pain to a level comparable to hamstring tendon grafts. Proper graft tunnel placement and orientation also remain controversial with several recent researchers arguing the ability to perform an anatomic reconstruction using a conventional endoscopic transtibial technique. We will describe a relatively simple and cosmetically acceptable 2-incision technique for harvesting a bone-tendon-bone graft. In addition, we will describe the bony landmarks that should be used to ensure proper anatomic graft placement and the appropriate angles that need to be used for the tibial tunnel to drill the femoral tunnel in an anatomic position and carry out a successful endoscopic transtibial tunnel anterior cruciate ligament reconstruction.
Conference Paper: Overlooked potential of systems with Markovian coefficients[Show abstract] [Hide abstract]
ABSTRACT: The usual system of linear stochastic difference equations with Markovian coefficients has been generalized to cover Rn valued processes which jump simultaneously with and due to jumps of the coefficients. The additional modelling potential is illustrated for a manoeuvring aircraft. Once being familiar with this overlooked potential of systems with Markovian coefficients, their use is remarkably simple. To filter partial observations of the generalized system candidate algorithms are reviewed, in particular the Generalized Pseudo Bayes algorithms and the more recent Interacting Multiple Model (IMM) algorithm. The IMM algorithm for the generalized system is applied to tracking a manoeuvring aircraft. The results indicate that the generalized models and the associated IMM algorithm has the potential to yield trackers that perform better than the existing decision-directed trackers.
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ABSTRACT: We present a review of the literature looking at the anatomy of the Anterior Cruciate Ligament, the biomechanical aspects of ACL reconstruction, review the outcomes of single and double bundle ACL reconstruction and present the current techniques for anatomic single bundle reconstruction.
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ABSTRACT: The purpose of this study was to investigate and report on a new intraoperative measuring technique to place the anterior cruciate ligament (ACL) femoral tunnel in the center of the native ACL femoral insertion site. We investigated a novel measuring technique based on identifying the proximal border of the articular cartilage and using a specific ruler parallel to the femoral axis to locate the origin of the ACL. The accuracy of this technique was validated by measuring tunnel position on postoperative 3-dimensional computed tomography scans. Bony tunnels created by the ruler technique were compared with tunnels drilled by a traditional technique referenced from the back wall of the notch. Fifty ACL reconstructions were performed by the novel measuring technique, with placement of the femoral tunnel at the center of the femoral insertion. The mean position for the center of the femoral tunnel measured by the ruler technique was 0.9 mm from the theoretic optimal center position but was a very distinct 5 mm from the mean position in the traditional tunnels. The ruler technique produced femoral tunnels comparable to published radiographic criteria used for tunnel placement and is reproducible and accurate. We recommend placement of the femoral tunnel at the midpoint of the lateral femoral condyle when using the anatomic single-bundle technique. Level IV, case series.
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