Anterolateral augmentation of ACL reconstruction
Dr. Porter may discuss this option with the patient if he feels that it is likely to be required. Most patients undergoing an ACL reconstruction do not require any additional stabilisation procedure, using the technique that Dr. Porter performs and as demonstrated in research that he has published previously in the medical literature (click on ). However is may be required in patients who are at higher risk of rupturing their ACL graft. This may include patients with long-standing ACL deficiency, those with lax knees (a "physiological pivot shift") and those who have already sustained an ACL rupture. It may also include patients who sustain damage to the anterolateral soft tissues of the knee, which normally assist the ACL in controlling the stability of the knee. The photograph above left demonstrates visible damage to these structures seen at the time of surgery in some patients. The photograph above right demonstrates the procedure being performed.
Operation
Dr. Porter may add the MITBT procedure to a knee that has already had an ACL reconstruction performed, or will perform it at the same time as the ACL reconstruction.
Following the completion of the ACL reconstruction, the knee is re-examined and if there is some evidence of persistent instability, Dr. Porter may add the MITBT procedure.
The procedure cannot be performed arthroscopically (i.e. it is not “keyhole”) and an incision is required on the lateral (outside) of the knee, as seen in the intra-operative photograph at the top of this page. The ITB is a broad ligament at the side of the thigh, a strip of this, 1cm in width and approximately 15cm in length, is used to perform the procedure. This strip of tissue is left attached to bone, but re-routed around the lateral ligament of thee knee and then re-attached to bone. The technique was modified in a manner that allows the surgeon to adjust the tension in the repair, so that it can correct the residual amount of instability, without un-necessarily over-tightening (or “over-constraining”) the knee before final fixation. The fixation is performed with the use of a screw that turns to bone, this avoiding permanent metal screws in the knee. This technique has been shown to add to the stability of an ACL reconstruction, in research performed by Dr. Porter.
To read the full paper written by Dr. Porter and published in the American Journal of Sports Medicine in 2020, click on the link below.
