Post on 14-Dec-2015
transcript
STIFINTRA ARTICULAR CCL RECONSTRUCTION
• STIF CCL ligaments are different for Right or Left joint to respect physiological torsion .
Recommended Ligaments and Screws• 25 -30 kgs : 30 fibres with free intra articular fibres of 15- 17-19 mm -
drill bit diam 3.6 mm - 5X20 screws• 30-35 kgs : 44 fibres - free fibers 22mm • Drill bit diam. 4.2 mm - 6X20 screws• Above 35kgs 60 fibres - free fibres 28mm• Drill bit 5mm 6X25 mm screws• The size of the ligament depends also of the size of the notch and the
bones . The strongest that can be used is recommended .
2 K wires 2mmX20cmDouble ended shqrp
Drill bits5mm -4.2mm- 3.6mm
6x wire loops
2 blunt K wires
Male screwdriver
Female screwdriver
2 hexagonal K wires
Telescopic tubesFor soft tissue protection
Passing tube 20 cm
STEP 2:the guide K wire is drilled down into the tibia
STEP 2 : the K wire is inserted downwards into the tibia from the femoral side.The flexion is ajusted to allow the penetration of the Kwire at the posterior part of the tibial CCL foot print
STEP 2b is :another option for the tibial K wire
If the orientation of the Kwire in the femur does not allow a proper direct placement in the tibia or leads to a friction of the ligament against the notch , the Kwire can be drilled separately with the joint in hyper flexion The Kwire is placed into the foot print and drilled down towards the medial tibial cortex
STEP 3 : drilling of the tunnels
The telescopic tubes are inserted on the K wire to protect the soft tissues; The cannulated drill bit adapted to the size of the ligament is guided by the K wire . The drillings are performed from outside-in to avoid damages to remnants and cartilage
Protection tube
Hold the Kwire during the tibial drilling
STEP 4 :passage of the ligament
The Wire passing tube is placed through the tunnels followed by the wire loop . The passing tube is removedThe threads of the ligament are inserted through the loop and the ligament is pulled until the free fibres are adjusted intra articularly
STEP 5 : femoral fixation
1or 2 cm of the hexagonal K wire are inserted into the tunnel parallel to the ligament. Then the appropriate screw is driven down and inserted with the female screw-driver until 1 mm remains outside the cortex . The telescopic tubes can be used if needed .
Hexagonal K wire
Cannulated screw
STEP 6 : adjustment of tension and tibial fixation
The ligament is tensioned once and then the joint is put in full flexion and extension. If the placement is isometric there should not be any movement in the tibial tunnel . A small sliding of 1or 2 mm is admissible and the tibial fixation must be completed to allow a full range of motion . The ligament must never be over tightThe insertion of the screw is made like on the femoral side with the help of the hexagonal K wire ; The male screw driver is used to adjust the insertion when the K wire has been removed
Note about fixation
The screws have to be tight in the bony tunnels. If there is a doubt about the strength of the fixation ( bone density –heavy and active dog ) it is recommended to drill a second transverse tunnel . Insert the extremity of the ligament in it and put a second screw