Table 3.

Pearls and Pitfalls of Using Supplementary Tibial Fixation in ACL Reconstruction With BTB Graft

Pearls

Two parallel transosseous tunnels are made with a 2-mm K-wire.

The tunnels are made from the tibial groove (10 × 25 mm) to the place where the tibial tunnel begins, which should be lateral to the insertion of the patellar tendon and superior to the sartorius fascia.

We recommend a 1-cm separation between the 2 tunnels.

Through the 2 tunnels, with the aid of 2 Abbocath devices, a No. 1 Prolene suture is passed, which will serve as a transport suture to pick up the high-strength suture (No. 5 Ethibond) from the tibial plug and introduce it into the tibial groove.

Both sutures are knotted, and the knots are left in the tibial groove, where they will not cause discomfort because they do not come into contact with the skin.

Pitfalls

Suture cutting through tibial bone

ACL, anterior cruciate ligament; BTB, bone-tendon-bone.