Compression Tubes for ACL Reconstruction
My compression tubes were on show at the 2017 American Academy meeting.
This is an innovation - and an idea I came up with about 3 or 4 years ago.
It was based on using pre-existing sizing tubes into which I pulled my grafts to try and squeeze fluid out of them to make them more 'conformed' and nicely shaped, and to also decrease the size of the graft so that when we did drill into the patient we could make the smallest hole possible.
This then led to a project with Arthrex where we developed these re-usable tubes that come in sizes from 5 mm all the way through to 13 mm - in half sizes - the idea being that you can pull the graft into the tube, you leave it there three or four minutes and initially it may be tight but after that sort of time the graft starts to move more freely. You can then take it out and pull it into the next size down. Sequentially you can downsize the grafts.
The average graft in the UK is between 8 and 8.5 mm, and we now get this down to half a size to 7.5 or 8.
That half size does make a big difference, particularly if you ever have to go back in and re-drill - the smaller the original tunnel the smaller the subsequent tunnel. And if the subsequent tunnel can be small enough it means that you can do the next operation - if you are unlucky enough to have to have the ligament revised - in one hit as opposed to having to have the original tunnel filled up with bone graft - 'polyfilla', if you like - and then waiting 6 months for that to take and then going in for a second procedure.
So it's all about making the operation as minimally invasive as possible.
For revisions, and for multi-ligament procedures, we often use allografts. And it is interesting how - because they are soaked in fluid - these down-size enormously. So a 12 mm allograft will often end up 9.5 mm once we have spent 20 minutes compressing it!
We're just about to release a biomechanical paper from Imperial College showing the science behind compression, and because it is just such an obvious concept it's been very popular with surgeons globally, and I am often congratulated for the idea - which is very nice.
