POSTER ABSTRACTS - ISAKOS

the femoral tunnel in routine fashion allowing for
aperture fixation at the entrance of the femoral
tunnel. All femoral tunnels were created by
placing an acorn drill bit through the medial
arthroscopy portal to the most posterior aspect of
the lateral wall of the posterior intercondylar
notch and flexing the knee to 120 degrees (in the
method described by Dr. Jack Andrish and others.)
Tibial fixation was performed by placing a 9mm by
30 mm allograft bone screw to the level of the
tibial articular surface under direct arthroscopic
visualization. Sutures in the tibial bone block
were tied over a post screw for supplemental
fixation.
There were no surgical failure in this group. All
patients improved at least on Grade on pre and
post-operative IKDC ratings and improved
between 1 and 3 levels on Tegner values. There
was one complication that occurred in the postoperative
time when the tip on one allograft screw
broke off and temporarily acted as a ''tehered
loose body''. There has been no significant tunnel
widening (less than 1-2 mm) on follow up X-rays.
In each case, the bone screws have incorporated
well into the surrounding bone as noted by X-ray.
Conclusions: The use of allograft bone screws and
aperature fixation of allograft patellar tendon
bone tendon bone arthroscopic assisted ACL
reconstructions is an effective method of
achieving ACL fixation and prevents significant
tunnel widening.
E-poster #337
Improved Technique of Anatomic
Reconstruction of Anteromedial and
Posterolateral Bundles of ACL - A Split Double-
Bundle Technique-
Chul-Won Ha, Seoul, KOREA, Presenter
Samsung Med Ctr, SungKyunKwan Univ Sch
Medicine, Seoul, KOREA
PURPOSE: This paper is to report an improved
technique of anatomic reconstruction of
anteromedial(AM) and posterolateral(PL) bundles
of anterior cruciate ligament(ACL). The two
bundles are separately tensioned and secured in
flexion and extension respectively to reproduce
more physiological tension. The broad tibial
attachment of ACL is reproduced by this
technique.
TECHNIQUE: Tibial and femoral tunnels are made
as usual. Tibial tunnel is then enlarged by reaming
5-7mm more anteriorly and posteriorly to make
the tibial tunnel elliptical in cross section. Most
kind of graft can be used for this technique. When
preparing tendon graft, the proximal portion is
prepared as in the conventional technique. The
distal portion is prepared as two separate bundles
by longitudinally separating the graft, creating a
Y-shaped graft.
The graft inserted into the femoral tunnel is fixed
with cross pins or a interference screw. The two
distal bundles are then oriented and positioned
by 90 degree rotation to each other as the normal
ACL. Then, the PL bundle is secured by post-tie
method around the distal orifice of tibial tunnel
under maximum manual tension, with the knee in
full extension. The AM bundle is then tightened
and secured with the knee in 70 degree flexion
with the same method. Then, an absorbable
interference screw was inserted between the two
bundles up to the upper end of the tibial tunnel
with the knee in 45 degree flexion. The
interference screw provide more tightening and
more anatomical position of the two bundles.
CONCLUSION: The split double-bundle technique
has the advantage of separate tensioning of the
AM and PL bundles of ACL and free choice of
graft. The two bundles of ACL can be more
anatomically located with minimal increase in
surgical difficulty. We believe it will result in more
physiologically functioning ACL. The technique is
also valuable in revision of failed ACL
reconstructions with enlarged tibial tunnel.
E-poster #338
Results of the Posterolateral Corner Sling for
Posterolateral Rotatory Instability Combined
Anterior Cruciate Ligament reconstruction
Young Bok Jung, Seoul, KOREA, Presenter
Suk Kee Tae, Seoul, KOREA
Yong Seuk Lee, Seoul, KOREA
Sang Hak Lee, Seoul, KOREA
Young Uk Park, Seoul, KOREA
Yong San Hospital Chung-ang University, Seoul,
KOREA
INTRODUCTION: The common cause of
ACL(anterior cruciate ligament) reconstruction
failures was unrecognized and untreated
concomitant PLRI(posterolateral rotatory
instability). We report the results of combined
PLRI and ACL treatment.
MATERIALS AND METHODS: From January 1998
to December 2002, twenty-nine consecutive
patients were included in this study, 24 patients
were followed-up for at least 12 months, a mean
of 25 months(range 12 to 58) postoperatively. The