ACL reconstruction with B-T-B autograft is considered the current golden standard. The essential benefit of this method is the healing of bone blocks in the metaphysis of femur and tibia, which is quick and easier for the body than the healing of the hamstring tendon into the bone. If we accept the premise that in biomechanical terms it is always more convenient to create a structure that relies on healing than a structure that relies on the strength of hardware, B-T-B reconstruction is the method of first choice. The disadvantages of the B-T-B graft described in literature can be minimised through the technique of the graft harvesting and its fixation.
An optimal technique that respects all the above mentioned conditions is a B-T-B graft reconstruction with press-fit fixation of the graft and with graft harvesting via two mini-incisions. We have more than twenty years of experience with this technique. Press-fit fixation provides an additional benefit. The site of the bone healing is not impacted in any way, and the healing takes place without any disturbances. There are no complications with implants, neither during the surgery or in the future. The graft is harvested subcutaneously via two longitudinal mini-incisions, which significantly reduces postoperative anterior knee pain (donor-site morbidity) and the occurrence of lateral hypesthesia in the innervation area of ramus infrapatellaris nervi sapheni.
Our technique using the Drillbone ACL Press Fit System allows for a gentle graft harvesting, anatomic and independent targeting of the tunnels, and precision positioning of the B-T-B graft via three 1.5 cm long mini-incisions. Following this surgery, patients can walk without crutches form the next day afetr surgery, and range of motion is not restricted in any way. It is the early ability to walk and unrestricted motion that are the benefits of our technique, and are the subtle factors that make a great difference. A high percentage of patients return to their preinjury performance, and no acceleration of degenerative changes are observed even after 20 years.