The surgical technique of Endobutton (Acufex Microsurgical, Inc,. Mansfield, MA) button fixation for anterior cruciate ligament reconstruction is described. TECHNIQUE FOR ACL RECONSTRUCTION USING THE. ACUFEX DIRECTOR DRILL GUIDE AND ENDOBUTTON CL. 데 . A doubled surgeon’s knot is used. The surgical technique of Endobutton (Acufex Microsurgical, Inc, Mansfield, MA) button fixation for anterior cruciate ligament reconstruction is described.

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Our minimally invasive procedure can facilitate a quicker recovery. In general, suspension of the EndoButton over soft tissue, such as the ITB, was weaker than that on the femoral cortex. Find articles techniqque Angela Chang.

There is a paucity of available literature regarding how to best remove interposed soft tissue endoburton reduce the position of the EndoButton. Several studies have shown that EndoButton malpositioning over the soft tissue around the knee induces either tissue irritation or migration of the button.

ICMJE author disclosure forms: This Technical Note describes an arthroscopic technique to prevent migration of the EndoButton using a femoral guide pin incision on the lateral aspect of the femur as an endoscopic portal.

However, arthroscopic ACL reconstruction is more technically complex, and inexperienced surgeons may have difficulty identifying the interposed soft tissue and EndoButton.

Endobutton button endoscopic fixation technique in anterior cruciate ligament reconstruction.

Received Mar 31; Accepted Jul Postoperative anteroposterior radiograph of a right Rt knee showing reduced EndoButton to lateral aspect of femoral cortex. The arrow indicates the EndoButtons of the anteromedial and posterolateral graft. Make an LF portal by longitudinally extending the guide pin incision.

A fixed-loop cortical suspension device, the EndoButton CL, is used for femoral fixation. Another potential complication is lateral extravasation because this technique is performed in the extra-articular space.

Support Center Support Center. Knee Surg Sports Traumatol Arthrosc. All-inside anterior cruciate ligament graft-link technique: National Center for Biotechnology InformationU.

Footnotes The authors report the following potential conflict of interest or source of funding: Postoperative clinical examination before revision showed range of motion without increased resistance. Switch the shaver to a Vulcan endobuutton to remove any interposed soft tissue beneath the EndoButton. Discussion This Technical Note presents an endoutton technique that successfully removes interposed soft tissue between the EndoButton and the lateral aspect of the femoral cortex and rndobutton EndoButton migration from the lateral aspect of the femoral cortex of the knee.

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However, this technique requires a longer intraoperative time and a relatively higher level of surgical skills that may limit its use to more experienced surgeons.

Some surgeons have recommended the use of intraoperative fluoroscopy to assess the position of the button and its relation to the femoral cortex. A standardized postoperative protocol is implemented for each patient.

Caution is need when removing the soft tissue over the lateral aspect of the femoral cortex. This Technical Note presents an arthroscopic technique that successfully removes interposed soft tissue between the EndoButton and the lateral aspect of the femoral cortex and reduces EndoButton migration from the lateral aspect of the femoral cortex of the knee.

The proposed procedure is routinely used in our practice and continues to show promise.

The arrowhead indicates the Vulcan probe. There is also a risk of damage to the EndoButton loop by using the Vulcan. If soft tissue is interposed between the EndoButton and lateral aspect of the femoral cortex, a radiofrequency RF probe Vulcan is inserted through another LF portal to remove the soft tissue.

Three femoral fixation devices for anterior cruciate ligament reconstruction: A Vulcan probe can also be inserted through the same portal to help manipulate and fit the EndoButton into technjque proper position at the lateral cortex of the femur by pulling the graft on the tibial side Fig 2 D and E.

The advantages of this arthroscopic technique include small incisions and direct visualization that can help remove any soft-tissue interposition and reduce a migrated EndoButton.

Confirm the migration of the EndoButton to the lateral cortex of the knee through the LF portal.

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The arrow shows the EndoButtons of the anteromedial and posterolateral graft. In addition, there is a small possibility of injury to the lateral superior genicular artery. Am J Sports Med. The previous studies showed a positive correlation between a malpositioned EndoButton and a higher rate of button migration. Seating of TightRope RT button under direct arthroscopic visualization in anterior cruciate ligament reconstruction to prevent potential complications.

Find articles by Hajime Utsunomiya. This technique tcehnique assist surgeons in understanding how to deal with and potentially avoid EndoButton migration during anterior cruciate ligament reconstruction. Iliotibial band irritation caused by the EndoButton after anatomic double-bundle endobuhton cruciate ligament reconstruction: Second-generation, no-incision anterior cruciate ligament reconstruction. Weakening of femoral fixation before graft integration might cause loosening of the reconstructed ACL and failure of the ACL reconstruction.

Femoral suspension devices for anterior cruciate ligament reconstruction: Physical therapy, consisting of exercise without resistance, to improve range of motion is initiated immediately after surgery. Several techniques have been proposed to ensure accurate placement of the EndoButton and lessen the probability of malpositioning. Open in a separate window. In the case in which the EndoButton migrates from the lateral aspect of the femoral cortex Fig 1 Aa lateral femoral LF portal is created through the femoral guide pin incision on the lateral aspect of the femur.

tevhnique Supplementary Data Video 1: We describe an arthroscopic technique for making femoral tunnels through the outside-in method that reduces the migration of the EndoButton through a lateral femoral portal. The described ACL reconstruction technique was arthroscopically performed by the senior surgeon. Migration of EndoButton after anatomic double-bundle anterior cruciate ligament reconstruction.