PMC3863517_01
Imaging of the knee showing the presence of intra-articular metal staple and a medial meniscus tear ((a), (b)).
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Plain radiographs revealed staples as the fixation method in his previous ACL reconstruction, with an intra-articular femoral staple (Figure 1(a)). Magnetic resonance imaging (MRI) showed absence of the ACL graft, a medial meniscus tear, and the presence of tibial and femoral metal staples (Figure 1(b)).
Arthroscopic view of the intercondylar notch showing the presence of the staple. There was space left for an anatomical femoral tunnel but there was concern with the staple affecting graft integrity.
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We did have space to perform an anatomic femoral tunnel, more posterior and distal on the lateral wall, but we were concerned with staple acting as a knife and cutting our graft once placed (Figure 2).
Lateral approach. The graft is designed on the ITB measuring 8-10 cm x 1 cm (a). The space under the LCL is developed, and the graft will be passed under it (b).
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The graft was designed having 8 to 10 cm in length and 1 cm wide (Figure 3(a)). The lateral collateral ligament (LCL) was identified and a space under it was developed (Figure 3(b)).
The graft is reinforced with strong, solid-core sutures to avoid graft damage when the interference screw is placed.
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We find it important to reinforce the graft with strong, solid-core sutures such as the Fiber-Loop (Arthrex, Naples, FL) to avoid graft damage when the interference screw is placed (Figure 4).
Final image of the tenodesis before closure.
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The graft is secured with an interference screw (Bio-Interference Screw, Arthrex, Naples, FL) (Figure 5).