A useful technique of using anterior cruciate ligament reconstruction jig for preparing patellar tunnel in surgical repair of extensor tendon ruptures

BACKGROUND

Quadriceps and patellar tendon injuries are common and require surgical intervention for best outcomes.^1,2 The current method of treatment involves whip suturing the tendons and passing them through the tunnel in the patella and tying the knots at the opposite end (Figure 1).³ However, making three equally spaced and parallel tunnels in the patella is often a daunting task.

Figure 1 .

Picture illustrating the arrangement of passing whip sutures through the patella

TECHNIQUE

We advocate the use of an anterior cruciate ligament (ACL) reconstruction jig (Figure 2) and a long wire to make such a tunnel in the bone. The angled bullets engage the cortex consistently and securely and the locking mechanism keeps the jig in place (Figure 3), hence guiding the entry and exit point. The tunnel is made with the help of a long wire and subsequently, sutures are passed through the tunnels with the help of a suture passer and are tied at the opposite end.

Figure 2 .

Anterior cruciate ligament (ACL) reconstruction jig. Image reproduced from www.nebulasurgical.com

Figure 3 .

Diagrammatic representation showing the use of the ACL jig to guide placement of tunnels in the patella. Image reproduced from www.sosbones.com.

DISCUSSION

This method can reproduce predictable tunnels in the patella for the surgical treatment of tendon injuries around the knee joint. This identifies the correct entry and exit point of these tunnels as intended by the surgeon without much guesswork. The holes are parallel and evenly spaced out. The depth of the tunnel could also be easily managed with this jig and this is easily available in most centres performing orthopaedic surgery.