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Diagnostic arthroscopy through standard arthroscopy portals
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Oblique linear incision 3 finger breadth below the joint line of 4-5 cm is made (Fig 1A) medial to the tibial tubercle along the direction of the semitendinosus tendon.
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The STT is isolated and harvested with a periosteum sleeve of 2.5 × 1.5 cm attached to it at one end.
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Free flap of periosteum of size 2.5 × 1.5 cm is harvested from the proximal tibia close to the pes anserinus attachment.
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The harvested tendon is whip-stitched on either end and quadrupled over a 25-mm fixed loop button (INFILOOP; Healthium Pvt Ltd., Peenya, BLR)—the attached periosteal sleeve is at the tibial end.
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The free periosteal sleeve is sutured to the femoral end of the graft such that, the cambium layer is on the outside.
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The intra-articular margins of the tendon marked by circumferential reference marking determining the intra-tunnel lengths of the graft.
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Sizing and determining the diameter of the graft and adjustments to the tunnel dimensions planned accordingly.
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Femoral and tibial tunnels are sequentially reamed to corresponding diameters of the graft.
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The graft is railroaded gently across the tibial tunnel into the femoral tunnel under arthroscopic guidance using a loop suture.
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Make sure that the periosteal sleeves on both the ends are within the tunnels and close to the intra articular margins—the circumferential reference markings will facilitate this observation.
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The INFILOOP button is flipped to establish the far cortex suspensory fixation on the femoral shaft. The tibial tunnel is fixed with variable pitch BTCP screw (Helysis, Healthium Pvt Ltd.) at 30° knee flexion.
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Supplementary fixation using the suture tails with transosseous suture bridge method (Fig 10B) is done.
