Bioabsorbable screws

After first performing arthroscopic examination in all cases, a probe was advanced to the lesion to determine its size and stability. The flexion angle of the knee joint was then adjusted manually, and bioabsorbable screws (Arthrex, Naples, FL, USA) composed of poly-L-lactic acid were used to perform the fixation. At least two bioabsorbable screws were used, and screw size was chosen between 2.5 mm × 18 mm and 3.0 mm × 18 mm depending on the size of the lesion. Here, the drill guide was located vertically on the lesion as much as possible, and the bioabsorbable screw was inserted vertically to provide axial pressure. Two or more bioabsorbable screws were used to provide roll stabilization. The bioabsorbable screws were inserted so as not to be exposed on the cartilage surface (Fig. 2). After the fixation, a probe was used to confirm solidity.
After surgery, patients were allowed to immediately flex the knee joint without limitations and do an isometric muscle strengthening exercise. No weight bearing was allowed for 6 weeks and crutches were used to permit partial-weight bearing for 6 additional weeks. Sports activities were permitted 1 year after the surgery.

Semitendinosus and gracilis tendons were harvested as described above. A combined ACL + ALL graft was prepared using a tripled semitendinosus tendon with an additional length of gracilis tendon sutured to it. The ACL portion of the graft (3 parts semitendinosus and 1 part gracilis) was fixed on both sides using bioabsorbable screws (Arthrex). The additional length of gracilis tendon that emerged from the femoral tunnel, at the lateral cortex, formed the ALL portion of the graft. This was passed under the ITB using a suture grasper, then through a tunnel in the proximal tibia, and back to the ALL origin, where it was tensioned and fixed with the knee in extension, completing double-strand anatomic ALL reconstruction.^{36 (link)}