Table 2.

Pearls and Pitfalls for the ACL Adjustable-Loop Fixation Technique

Pearls

Maintain a forceful constant distal traction on the tibial tails of the graft during graft advancement to prevent the button from rapidly exiting the femoral socket and through the iliotibial band. Not doing so will prevent the button from sitting flush on the lateral femoral cortex.

Cycle the knee twice: (1) after advancing the graft into the knee and once the button sits flush on the lateral tibial cortex; and (2) after the tibial interference screw is tightened and fully seated within the sheath.

Leave the graft 5 mm short of the femoral socket terminus to allow for space in the socket for retensioning.

Use the aid of a guidewire when inserting and tightening the screw into the GraftBolt sheath.

After graft retensioning, consider knot tying of the white tensioning sutures to limit potential loop slippage that may occur with cyclic loading of the knee during postoperative rehabilitation.

Pitfalls

The cortical suspensory button may not sit flush on the lateral femoral cortex if it is accidentally advanced outside of the femoral socket and into surrounding soft tissues, such as the iliotibial band.

Failure to sufficiently retension the graft construct. Use Kelly clamps to pull forcefully on the white tensioning sutures after tibial fixation has been achieved to remove graft laxity and ensure the graft is tight in flexion and extension.

ACL, anterior cruciate ligament.