“Over the Top” Augmentation for Partial Anterior Cruciate Ligament Tears Using Suspension Device for Tibial Fixation

Abstract

A technique for augmentation of the partial anterior cruciate ligament is presented. The patient is positioned supine with the knee flexed 90°. After addressing intra-articular injuries, the autologous semitendinosus tendon is harvested and measured in a doubled manner; after that, the tibial tunnel is performed in the outside-in direction, of the same diameter of the doubled graft. Both ends of the graft are sutured together, after inserting it through the loop of a suspension device, which is attached in its augmentation piece. A lateral femoral incision is made, to approach the joint through the “over the top” position. A looped thread is introduced inside the joint with the aid of a hook. This thread pulls the graft's sutures through the “over the top” position. A femoral tunnel is then drilled in the lateromedial and caudocranial direction. The suspension device is attached to the anterior tibial cortex and the graft is pulled in the caudocranial direction to the femoral tunnel, where an interference screw is used for fixation.