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Rupture of the anterior cruciate ligament of the knee



In certain sports, home, and work injuries, the knee can experience severe distortion that causes rupture of the anterior cruciate ligament, one of the four ligaments that connect the tibia to the femur in the knee joint. 


Typical accidents that can cause anterior cruciate ligament tear:




Horseback riding


here is what can happen during a strong distortion or sprain of the knee:


The ruptured ligament is generally irrecoverable, because it is frayed and practically destroyed. It must be replaced by a graft, that is, another tendon must be taken nearby to be used as a replacement for the cruciate.

Technique using the semitendinosus tendon:

One takes as transplant one of the hamstring tendons, on the medial side face of the thigh: the tendon of the "semi-tendinous" muscle (below, on the left). It is made into a four-strand transplant (below, right).

Alternative method using the quadriceps tendon:


For years I have been using the so-called semi-tendinosus technique, or DIDT, in which one or two of the three tendons that run on the inner side of the thigh are removed. This technique works very well and has been proven. However, as the anatomy of the semitendinosus is quite variable, in some individuals it is too thin, so that sometimes two tendons have to be taken instead of just one, and even with two, sometimes the transplant is one insufficient. In my experience, this is more often the case in women than in men, as well as in shorter individuals.


An alternative technique recently proven by many studies solves this problem of the variation of the anatomy: the harvesting of the tendon of the quadriceps.


The quadriceps muscle begins at the pelvis and attaches to the top of the kneecap. It is one of the largest muscles in the body, and also one of the most powerful, responsible for extending the knee, and thereby walking, running and standing. A strip of about 1 cm width in the middle of the tendon, which is then sewed together, without great damage to the muscle.

Although the exact length of the tendon varies somewhat between individuals, its thickness and strength are constant.

A solid transplant can therefore be obtained in all cases, whether the patient is a man or a woman, slender or stocky, tall or short.


Whatever technique is used, the transplant is then placed inside the knee, imitating the original course of the ligament, by means of small bone tunnels, one in the tibia, and another in the femur. The new ligament will then gradually fix itself biologically in the tunnels. In the beginning, it is naturally necessary to fix it so that it does not move until it is healed to the bone of the tunnels. At the level of the femur, two small absorbable pins are used which cross the tunnel and therefore secure the transplant, and in the tibia, the traction sutures of the transplant are tightly knotted on a 3.5 mm stainless steel screw, which in principle does not need to be removed.

Here are the skin incisions in these two techniques:

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semitendinosus technique            

quadriceps technique

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