This update follows my previous presentation on Anatomical ACL.
Two prominent surgeons, Freddie Fu and Charlie Brown, have been working on the idea of anatomical ACL reconstruction. They would stand up at meetings and say “I’ve done 5,000 ACL reconstructions and looking back at what I was doing I now think that I put 5,000 ACLs in the wrong place because we now know that we have been putting it in the wrong place. Although we can get an excellent clinical result, almost everyone that has an ACL reconstruction will eventually go on to develop osteoarthritis.”
This is because if you put the ACL in a functional but non-anatomical position it captures the knee and it changes the way the knee moves. So as a result of that you can have an elite athlete playing elite sport, but if this ‘piece of string’ that you put into their knee is not where it is supposed to be – you have not put it in the correct anatomical location – you change the way the knee moves very subtly and the knee reacts to that. Over ten to fifteen years if you don’t take an X-ray – even if an individual hasn’t got any symptoms - you see the beginnings of osteoarthritis.
Last April (2009) a UK surgeon, Tim Spalding, launched his ideas at BASK with an excellent presentation last April (2009) in Oxford where he demonstrated an improved method of locating the real anatomical position for a single bundle procedure – what they are calling the direct measurement technique for ACL surgery. He has now followed that up with a clinical study with high-resolution CT scanning and that article has just been submitted for publication. The new ‘buzz’ way of describing an anatomical ACL reconstruction is called ‘footprint’ ACL surgery or ‘anatomical’ ACL surgery. Tim Spalding and his group have now done a very in-depth study looking at this work over the last year and they have found a very high degree of accuracy between the direct measuring technique that they developed correlated with CT scans to show that they have had a great success in putting the ACL exactly where it should be.
I have been working on a new technique that facilitates the placing of the new ligament in this real anatomical position – doing all the work from the medial side, which is much easier than the old techniques. So you actually look from the medial side and do all the work from the lateral side with some special instruments that go around the corner into the notch and allow you to prepare the femur, mark the femur and then accept this drill bit.
I would like to show you this method which I have illustrated via live surgery in Garmisch, in Southern Germany in 2011 (location of 2011 World Ski Championships) when I was presenting my approach to the German arthroscopic association, and you will find the video below.
This is the view from the patient’s room!
Here are two photos - one showing the surgical staff preparing the patient for surgery while the other shows the recording team seeing to the video and sound equipment.
The next two photos show the surgical team in action looking up at the monitor with the arthroscope on the medial side - you can see how busy it all is with the video crew and the surgical team all in the room together!
Finally, I will show you a video of the new procedure if you click this link - http://www.youtube.com/watch?v=vKVcibPApPU.