The All-inside Translateral Technique for Cruciate Surgery
The current focus in ACL surgery is on restoring the anatomy as far as possible and stabilising the knee to prevent damage to the joint cartilage - what is referred to as 'anatomical ACL reconstruction'. This is made easier by the all-inside translateral approach.
All-inside translateral technique - advantages
Better anatomical positioning
Our 'translateral approach' makes anatomical reconstruction a much less challenging procedure, and the new instrumentation makes it much easier to navigate to the correct position for the new ligament.
Soft-tissue preservation
Our soft-tissue preserving technique utilises where feasible a quadrupled semi-tendinosis autograft, preserving the gracilis to retain stability, strength and proprioception, or for use in another ligament procedure such as ALL (anterolateral ligament), PLC/FCL (posterolateral corner/fibular collateral ligament) or MPFL (medial patello-femoral ligament).
Where necessary when we need a bigger graft, we combine semi-T and gracilis into an 8-strand Graftlink.
Where allograft is indicated, a single allograft offers a huge cost savings, and one can use semi-T, peroneus longus, the tibialis anterior tendon or quads tendon.
Less bone loss
Sockets have the advantage over tunnels of less bone loss.
TriLink
The TriLink technique allows surgeons to perform minimally invasive ACL reconstruction with the benefits of a double bundle graft construct while only harvesting a single hamstring tendon.
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THE 'TRANS-LATERAL' APPROACH HAS LED TO NEW INSTRUMENTATION
The all-inside 'trans-lateral' approach has led to the development of new techniques and instrumentation:
- GraftLink
- RetroDrill
- FlipCutter
- TightRope
- FiberStick
- TriLink
I have helped in the development of both the surgical technique and the instruments for the all-inside procedure and pioneered the procedure in the UK and on the world stage.
GraftLink
A GraftLink is the term we use for our 4-strand graft, a graft prepared via a specially-constructed workstation to allow a highly reproducible construct to be created. A single hamstring tendon is harvested (usually semitendinosis), so there is less potential morbidity to the patient. We do sometimes use allograft, too.
The workstation simplifies graft preparation, creating a tapered graft that allows tensioning from both the tibial and femoral sides (via the TightRopes).
The Femoral Socket
A socket - rather than a tunnel - allows wider bone removal to accommodate the ends of the graft, but much less bone removal for the TightRopes that tension and the TightRope buttons that fix the graft.
The femoral socket can be prepared from the medial portal using the TightRope drill pin, or from outside-in using a RetroDrill such as the FlipCutter II.