now inside the knee joint
this my probe the full I'm but the five runs on the top the shin bruise on the
bottom
the inner or medial meniscus cartilage is here
we're looking all the way to the back to the periphery
I don't see any evidence
tearing up the inner or medial meniscus looking up underneath
all the way out to the periphery looks good there
no rips and none out here
an excellent I'm you see a nice and smooth the articular cartilage is on the
Famer and on the tibia so we're gonna map that friendly got all the way
and then placing a back that's nice and smooth
just gonna slip through the center the joint film
gonna go awry pastor post post your order the
the medial meniscus and that's not torn
back here so we're back behind any post your yearly and
medially pushing up from behind that looks good there
rotating the scope centralia withdrawing we see
the post your your cruciate ligament their those would come on out here
we can see the area where the anterior cruciate ligament
was supposed to be this is a little bit of
membrane called the ligamentum
Yuko some too many come in with my shaver year in clearance some this out
improve our visualization
you can see the stomp the old ACL
right there as we've got that exposed
so that's the torn ACL right right in here
see how that's damage right there
gonna clear out all the more this
soft tissue making all these are you expose things
okay now we're going to slide on over into the lateral
compartment in a joint so this is the thigh bone on the top the shin bone on
the bottom
the lateral meniscus looks good back here all the way to the
the it's all been a certified as
right back here in the area around the popliteal tendon
which is the structure right here but the lateral meniscus looks great
which is excellent for the prognosis probe police
good but my program here lift up the lateral meniscus we look down to see the
continuation of the popliteal tenant right down here
underneath the lateral meniscus that's fine the anterior horn Letterman discuss
looks great
so when the map 25 bones trembling on all the way
this is big torn and anterior cruciate coming into place
was sleeping on back we're back behind the post your yearly and latterly
pushing up from behind that looks good
see some scar tissue associated with torn ACL
so the ACL is completely detached
is nothing left but little room that here
and it's supposed to be right back in there that little things ticking down as
for the ACL suppose to
to originated now we're coming up into the lateral gutter
I mean the media got her as restrain the leg out this allows us to slide on up
and look up underneath the cap
we see our water inflow cannula over here
sliding back and forth this
the cap works great no evidence to damage
really clear the lateral got her may be sure there's no loose bodies are
problems there
so the latter better looks good
you see the torn ACL stump right there
going back up again looking at the under surface the kneecap
this looks good and smooth so is reflected in the will drop down
but be able to look at the period torn anterior cruciate ligament
the next step is to clear this out preparation for placing are graphed
so I've got my shaver in a
slightly in a different portal see part in this anterior cruciate ligament
a test itself to the poster cruciate ligament which is this
we're gonna clear this out
and get this stump clear that here
27 plays
the the best the command the it trans
T and here
you have a lame inflame quiet place region with a grasping instrument
grab that pull an hour
okay so we got this ACL removed among open up the
anaconda national bird
the burner raising the roof man riding a wall here
the there were clear the
soft tissue and the hard tissue back the a
so that they got a good
goods sandner for the notch
with the new graph on cutter
get pensioners and he goes through its range motion
sure the now removed the bone
that would too use the shaver to
do this and a little bit more
okay so we look back up here
and our previous ACL attachments I
right there and that's really what the to go
good before we start tunnel
the we're gonna play some internal
for the tibia down in this area
an employer in this out in preparation for
for that step
so now we've got a guidewire and I'm place here
I'm GATT which were placing in about 36
eight or nine millimeters in front of the
are PCLN we're gonna pass a guide
I wire up through that so now we've got our
not do the peer into the tibia
gonna clear the debris from around it
3 bring our shaver up through the tunnel
me see this is in the old
howell et al the old iPad
attachments I did the ACL and there were
within about two to three millimeters on the PC on here
next step is to pass our guide wire up into this area
really use a chance to be your guide which will slide up in the position
has a flanges slips off to the side here
will rotate this around a little bit we see the antarctic emissions around 25 28
millimeters the flanges
of the back
want the need to be flexin ninety degrees I'm
they were to pass a guide wire up through this
as a rotated over
and will come up through the side the thigh
we're not gonna move the chance to be your guide
and we're gonna look back here
see where we are like rene years
the post your your area
at the shaver up in here clear that an hour
I haven't
but pressure thank you
so we're just back up the Intercon the ridge
in the center the attachment side OVR
I'll cruciate a ligament right there
so we're going to overdraw this with the cannulation
reamer me gonna put this guy have been here
have one to trade on a cannula please now uses cannula to evacuate the bone
dust
who is smooth and out
really continue to flush the debris out other
now to the post your joint make sure
it's free phone just
there's a little bit they're so used to share and it was a vacuum
went back
okay good
now we're gonna make a notch
appear in the top of our femoral tunnel
now make it easier for us to put in our guide where may have the cure at police
come in with a cure at
and
to breed this little bit more open and up
so it's again like I said it's easier for other
guy you are going there and I'll put the shaver back in
and what I D things up now
my physician assistants and preparing the graft
and it's now ready for insertion trauma to drain the
the joint of water
to facilitate this niche process k we've trained the
near water now we're going to withdraw the guide wire which brings the sutures
which are attached to the graft
up in a place the sutures in turn bring our graft up in a place
and I am A have the pro please help with the probe in here
line that up
or moving around like this
so we've got this plugged approve we wanted
in the femur their blue line is the
demarcation between the phone and the tendon
and this is a little notch we created so we can synar
a guide wire up in there okay
we looked at the tibial side that looks good so the next step
is to secure this in place right appear with the body great all
interference screw so now we're dancing the bottle composite interference screw
up in the interval between the bone played
and the femur to secure the upper Intergraph
you see you know that secure and that nicely appear okay
so we're gonna go through a range emotion train delay on all the way out
doesn't rub up against the side
against the top good
thanks a back down
so the final step is to secure the lower into the Grafton
in position within a hour a similar screw
we've not got our lower screw in place for checkin attention
as reflex in a way to get a good tension there
the graft is not rubbing up against the side are on the top
Alex gray
this concludes the arthroscopic surgical procedure