This technical article presents a novel and reproducible surgical technique known as the “Translateral” approach, designed for anterior cruciate ligament (ACL) reconstruction. It focuses on an all-inside single-bundle reconstruction that uses a short, quadrupled semitendinosus autograft in combination with a lateral extra-articular tenodesis. This combined method aims to address both the ACL tear and associated knee instability, offering a comprehensive and minimally invasive solution for patients.
Evolving Surgical Concepts for Knee Stability
Traditional ACL reconstruction techniques, particularly the transtibial method, have often been criticised for placing the femoral tunnel in a non-anatomical, vertical position. This can lead to persistent rotational instability, which is a major factor in ACL graft failure. Anatomic reconstruction has emerged as a superior approach, aiming to replicate the native ligament’s function and orientation more accurately.
The all-inside technique is a key advancement in this evolution. It minimises surgical trauma by using closed-end sockets instead of full tunnels, thereby preserving more bone stock and reducing post-operative pain. This is particularly beneficial in revision surgeries where previous tunnels may be a challenge. The Translateral technique specifically refines this approach by using retrograde drilling, which allows for precise femoral and tibial socket creation without the need for an accessory medial portal or knee hyperflexion.
The Short Graft and Lateral Tenodesis Advantage
A critical aspect of this technique is the use of a short, quadrupled semitendinosus graft. This offers a number of advantages, including a high degree of stiffness and tensile strength, while also reducing morbidity associated with harvesting a larger graft. The study highlights that even in cases where the semitendinosus tendon is thin, this technique can still be effectively performed.
Furthermore, the integration of a lateral tenodesis is a significant component of this procedure. The lateral tenodesis helps to manage anterolateral rotatory instability, a common issue that a single ACL reconstruction may not fully address. By tightening the external structures of the knee, this additional procedure improves overall rotational stability and reduces the risk of re-injury, particularly for high-level athletes engaged in pivoting sports.
This combined approach of an all-inside technique with a short graft and lateral tenodesis represents a fusion of modern principles aimed at achieving optimal outcomes. The emphasis is on restoring the knee’s anatomical and biomechanical function as closely as possible, ensuring long-term stability and a safer return to activity for patients.
For a detailed look at the study’s full findings, methods, and analysis, you can read the original paper.
Sources used in report overview:
- https://journals.lww.com/international-journal-of-surgery/fulltext/2013/10000/anatomical_acl_reconstruction_using_the.449.aspx
- https://www.researchgate.net/publication/315462947_Combined_All-Inside_Anterior_Cruciate_Ligament_Reconstruction_and_Minimally_Invasive_Posterolateral_Corner_Reconstruction_Using_Ipsilateral_Semitendinosus_and_Gracilis_Autograft
- https://www.arthrex.com/resources/DOC1-000730-en-US/distal-femoral-osteotomy-scientific-update
