PMC7276576_01
Magnetic resonance imagingT1-weighted image confirming the proximal anterior cruciate ligament tear with good tissue quality.
JOCR-10-11-g001.jpg
PMC7276576_01_JOCR-10-11-g001.jpg
F1
Radiographic examination showed regular bony configuration of the left knee with no associated fractures while magnetic resonance imaging (MRI) confirmed a proximal ACL tear with no evidence of concomitant chondral/ meniscal/ ligamentous injuries (Fig. 1).
Arthroscopic view of the anterior cruciate ligament tear with a proximal tear pattern (Sherman type 1), good tissue quality, and an intact synovial coverage.
JOCR-10-11-g002.jpg
PMC7276576_01_JOCR-10-11-g002.jpg
F2
The ACL tear presented with a proximal tear pattern (Sherman type 1), good tissue quality, and an intact synovial coverage so that an arthroscopic ACL repair using internal brace augmentation was performed (see surgical technique below, Fig. 2, 3, 4). The ACL was carefully assessed, including tear pattern, tissue quality, and synovial coverage of the ACL remnant: Aproximal ACL tear (Sherman Type 1) with good tissue quality and an intact synovial coverage as well as no concomitant osteochondral lesions nor meniscal injuries were present in both arthroscopies (Fig. 2 and 6).
The labral Scorpion suture passer (Arthrex; Naples, USA) is used to pass a No. 2 FiberWire  (Arthrex; Naples, USA) through the anterior cruciate ligament remnant.
JOCR-10-11-g003.jpg
PMC7276576_01_JOCR-10-11-g003.jpg
F3
The ACL tear presented with a proximal tear pattern (Sherman type 1), good tissue quality, and an intact synovial coverage so that an arthroscopic ACL repair using internal brace augmentation was performed (see surgical technique below, Fig. 2, 3, 4). An ACL repair utilizing an internal brace augmentation was performed in both cases as popularized by van der List and DiFelice: Using a labral scorpion suture passer (Arthrex; Naples, USA), a No. 2 Fiber Wire  (Arthrex; Naples, USA) was passed 3 times through the ACL remnant - approximately 1cm distal to the ACL tear (Fig. 3 and 7).
Completed anterior cruciate ligament repair using internal brace augmentation.
JOCR-10-11-g004.jpg
PMC7276576_01_JOCR-10-11-g004.jpg
F4
The ACL tear presented with a proximal tear pattern (Sherman type 1), good tissue quality, and an intact synovial coverage so that an arthroscopic ACL repair using internal brace augmentation was performed (see surgical technique below, Fig. 2, 3, 4). Using the femoral and tibial shuttling loop, the Internal Brace construct consisting of a Tight Rope (Arthrex; Naples, USA) armed with a Fiber Tape (Arthrex; Naples, USA) and the Fiber Wire  suture was carefully shuttled through the tibia and femur so that the Tight Rope  button flipped at the femoral cortex (Figs. 4 and 8).
Magnetic resonance imagingT1-weighted image confirming the proximal anterior cruciate ligamentretear again, with good tissue quality.
JOCR-10-11-g005.jpg
PMC7276576_01_JOCR-10-11-g005.jpg
F5
Consequently, an MRI scan confirmed the diagnosis of a proximal ACL retear (Fig. 5).
Arthroscopic view of the anterior cruciate ligamentretear with a proximal tear pattern (Sherman type 1), good tissue quality, and an intact synovial coverage.
JOCR-10-11-g006.jpg
PMC7276576_01_JOCR-10-11-g006.jpg
F6
Intraoperatively, the ACL retear presented with a replicated proximal tearpattern (Sherman type 1), good tissue quality, and an intact synovial coverage so that an arthroscopic ACL re-repair using internal brace augmentation was performed (Fig. 6, 7, 8). The ACL was carefully assessed, including tear pattern, tissue quality, and synovial coverage of the ACL remnant: Aproximal ACL tear (Sherman Type 1) with good tissue quality and an intact synovial coverage as well as no concomitant osteochondral lesions nor meniscal injuries were present in both arthroscopies (Fig. 2 and 6).
A No. 2 FiberWire  (Arthrex; Naples, USA) suture is passed through the anterior cruciate ligament remnant with a labral scorpion suture passer (Arthrex; Naples, USA).
JOCR-10-11-g007.jpg
PMC7276576_01_JOCR-10-11-g007.jpg
F7
Intraoperatively, the ACL retear presented with a replicated proximal tearpattern (Sherman type 1), good tissue quality, and an intact synovial coverage so that an arthroscopic ACL re-repair using internal brace augmentation was performed (Fig. 6, 7, 8). An ACL repair utilizing an internal brace augmentation was performed in both cases as popularized by van der List and DiFelice: Using a labral scorpion suture passer (Arthrex; Naples, USA), a No. 2 Fiber Wire  (Arthrex; Naples, USA) was passed 3 times through the ACL remnant - approximately 1cm distal to the ACL tear (Fig. 3 and 7).
Completed anterior cruciate ligament repair using internal brace augmentation.
JOCR-10-11-g008.jpg
PMC7276576_01_JOCR-10-11-g008.jpg
F8
Intraoperatively, the ACL retear presented with a replicated proximal tearpattern (Sherman type 1), good tissue quality, and an intact synovial coverage so that an arthroscopic ACL re-repair using internal brace augmentation was performed (Fig. 6, 7, 8). Using the femoral and tibial shuttling loop, the Internal Brace construct consisting of a Tight Rope (Arthrex; Naples, USA) armed with a Fiber Tape (Arthrex; Naples, USA) and the Fiber Wire  suture was carefully shuttled through the tibia and femur so that the Tight Rope  button flipped at the femoral cortex (Figs. 4 and 8).
Magnetic resonance imagingT1-weighted image at 12-month follow-up confirming the integrity of the re-repairedanterior cruciate ligament.
JOCR-10-11-g009.jpg
PMC7276576_01_JOCR-10-11-g009.jpg
F9
MRI at 12-monthfollow-up confirmed the integrity of the repaired ACL (Fig. 9).