Arthroscopic Reconstruction of the Anterior Cruciate Ligament on X-ray Image Control

Open surgery for reconstruction of anterior cruciate ligament (ACL) such as Insall method required large incision and long period of post-operative immobilization. Arthroscopic surgery has many advantages in comparison with open surgery such as small incision, minimmum scar formation, preventing muscle damage and so on.Our technique for ACL reconstruction under X-ray control is reported. Initially, arthroscopic meniscectomy and/or meniscal suture are done. Then 3cm skin incisions are made on lateral femoral condyle and anterior of the tibia. After exposure of the cortex, 1.5mm Kirshner wires are inserted under X-ray image.The isometric points for ACL reconstruction are just posterior and superior region of the femoral attachment and anterior medial site of the tibial attachment.Following these Kirshner wires, stepped bone tunnels are made using 5mm and 8mm reamers. Then the Leeds-Keio's artificial ligament is passed carefully and fixed with bone plugs and staples.If necessary, extra-articular reconstruction is done. After a week of immobilization, the device of continuous passive motion is applied and three weeks later, partial weight bearing is permitted using the Lenox-Hill brace. Although the follow-up period is short as long as 4 months, range of motion and stability are better with our present method than our previous open method.