ACL Reconstruction Failure

Description

Mr Sam Oussedik gives his expert insights and provides an in-depth overview of the critical factors involved in ACL (Anterior Cruciate Ligament) reconstruction, detailing three essential steps to ensure successful patient outcomes: graft selection, tunnel position, and fixation. Mr Oussedik emphasizes the importance of correct tunnel positioning as the most vital aspect of the procedure.



He begins by outlining that achieving the correct tibial tunnel position, corresponding accurately to the ACL's anatomical footprint on the tibia, is crucial for developing effective clinical practices. Key landmarks on the tibia can aid in identifying the appropriate tunnel site, though reliance on the ruptured stump alone can be misleading. Mr Oussedik cautions against misplacing the tunnel either too anteriorly, which risks impingement and cyclops lesions, or too posteriorly, which can compromise graft orientation and rotational stability.



The femoral tunnel position poses additional challenges, with various placement strategies discussed—from traditional transtibial approaches to more anatomical placements near the back of the notch. The preferred method is to ensure that the tunnel apex aligns with the notch apex and remains safely contained within the lateral wall of the notch. Deviation from these established guidelines can lead to significant risks of surgical failure.



Overall, the message conveyed by Mr Oussedik is that meticulous attention to tunnel placements in ACL reconstruction is paramount, and surgeons should seek hands-on training and guidance from experienced colleagues to master these techniques.

DOI: 10.1302/3114-251258

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