Hybrid anterior cruciate ligament reconstruction: introduction of a new technique for anatomic anterior cruciate ligament reconstruction.

Recently, anatomic or double-bundle reconstruction of the anterior cruciate ligament (ACL) has been presented in an effort to more accurately restore the native anatomy. These techniques create 2 tunnels in both the femur and tibia to reproduce the bundles of the ACL. However, the increased number of tunnels, particularly on the femoral side, has raised some concerns among authors and surgeons. We describe a technique to reconstruct the 2 distinct bundles of the ACL by using a single femoral tunnel and 2 tibial tunnels, the "hybrid" ACL reconstruction. The femoral tunnel is drilled through an anteromedial arthroscopy portal, which allows placement in a more anatomic position. Fixation in the femur is achieved with a novel device that separates a soft-tissue graft into 2 independently functioning bundles. Once fixed in the femur, the anteromedial and posterolateral bundles of the graft are passed through respective tunnels at the anatomic footprint on the tibia. These bundles are independently tensioned, which creates a reconconstruction that is similar to the native ACL. The technique presented provides surgeons with an alternative to other double-bundle techniques involving 4 tunnels.

Transhumeral head plasty for large Hill-Sachs lesions.

Large, engaging Hill-Sachs lesions can cause recurrent glenohumeral instability following Bankart repair of torn anterior capsulolabral structures. We offer a novel technique for correcting the posterolateral humeral head defect without significantly altering normal anatomic structures. The glenohumeral joint is exposed via a deltopectoral approach. After the defect geometry is appreciated by direct palpation and visualization, the tip of an anterior cruciate ligament tibial guide is centered in the defect. The drill sleeve is approximated to the anterior lesser tuberosity starting hole, and a graduated guidewire is advanced to the posterior subchondral surface. After confirmation of satisfactory positioning, an 8-mm cannulated acorn drill is drilled to within 1 cm of the posterior surface. Bone tamps are used to elevate the depressed area using the tunnel created within the head. Allograft cancellous bone chips are impacted into the defect to elevate and support the subchondral surface. After successful impaction grafting and restoration of the head surface, anterior capsulolabral reconstruction is undertaken using either the Bankart or Latarjet technique. A standard Bankart rehabilitation program is followed postoperatively. We confirmed the clinical efficacy of our technique in 4 patients who experienced no instability or other complications at an average of 1-year follow-up.