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EndoCap

Tibial graft fixation system for anterior cruciate ligament reconstruction
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EndoCap
Tibial graft fixation system for anterior cruciate ligament reconstruction
The use of interference screws for graft fixation in anterior cruciate ligament reconstruction promotes the bone tunnels widening due to crushing of the cancellous bone and limits the contact area between the graft and the wall of bone tunnel. Cortical fixation is devoid of these drawbacks, but its use leads to the bone tunnels widening due to the movements of the graft in tunnels.

To solve these problems we have developed a simple and reliable method of cortical fixation of the graft for anterior cruciate ligament reconstruction.
Surgical technique
1
After semitendinosus tendon harvesting the graft is folded in half.
2
Both ends of the tendon are sutured together with a non-absorbable suture.
3
The graft folded in half is passed through the loop of the femoral cortical button, one of the ends of the thread with which both ends of the graft are stitched is passed into the formed tendon loop of the graft, the graft is fixed in a taut state on the preparation table.
4
The proximal and distal ends of the graft are stitched with circular sutures made of non-absorbable suture material, passing through all the graft bundles in the transverse direction.
5
Start to stitching the proximal and distal ends of the graft according to the scheme with corrugating sutures 3,4 (non-absorbable suture material). Stitching is shown using the example of the distal end of the graft (green threads). Blue threads come from the proximal corrugating suture. Corrugating sutures provide additional intra-tunnel tight fixation of the graft by increasing the diameter of the graft after pulling the ends of the corrugating sutures.
6
Appearance of the prepared graft (with proximal and distal corrugating sutures).
7
Appearance of the prepared graft after threading in pairs into the holes of the EndoCap
8
After the preparation of the femoral and tibial bone tunnels in the isometric areas femoral cortical fixation of the graft is performed.
  • The ends of 3 pairs of threads, which exit through the tibial bone tunnel, are divided and threaded in pairs into the holes of the EndoCap from its lower surface (from the side of the "spikes") so that the knots of the paired threads are located above the "bridges" between the holes.

  • The EndoCap is grasped at the flat edges with a surgical clamp, positioned so that the "visor" mark is pointing up.

  • EndoCap is positioned at the exit of the tibial bone tunnel in such a way that the "visor" is completely immersed in the bone tunnel and rests against the proximal edge of the external aperture of the tibial bone tunnel.

  • In a constant tension position with a 30-degree flexion at the knee joint the threads coming out of the holes of the EndoCap are tied in pairs over the "bridges" between the holes in the following sequence: first black threads, then green threads (from the distal corrugating suture), then blue threads (from the proximal corrugating suture). Important note: the ends of the corrugating sutures are tied after preliminary alternate pulling (due to which the ends of the graft sewn with corrugating sutures are thickened in the bone tunnels).
Features of the EndoCap tibial button
EndoCap unlike traditional tibial cortical buttons provides the most stable fixation due to design features that take into account the oblique course of the tibial tunnel during anterior cruciate ligament reconstruction. Traditional button on the top, EndoCapTM on the bottom.
Features of the EndoCap tibial button
  • EndoCap is universal fixation device - it allows cortical fixation of soft tissue grafts in tibial tunnels with a diameter of 8 to 12 mm, which allows it to be used in primary anterior cruciate ligament reconstruction and in revision cases.
  • A special "visor" on the fixation device effectively prevents its displacement in the proximal direction when tensioning the graft fixing threads.
  • Special "spikes" on the lower surface of the fixation device prevent the button from rotating after tightening the threads and significantly reduce the pressure on the periosteum around the entrance to the tibial tunnel.
  • A mark on the upper side of the button indicates the location of the "visor" on its lower surface for precise positioning.
  • Flat edges on the sides of the "visor" allow you to conveniently grip the locking device with clamps, greatly facilitating its installation.

CLINICAL CASE

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About Specialist Surgeon
Vladimir SLASTININ
Slastinin Vladimir Viktorovich, born in 1984 in Kaluga, Yaroslavl State Medical Academy graduate in 2007.

Resident in orthopedic department in Sklifovsky Clinical and Research institute for Emergency Care in 2007-2008.

From 2010 to 2017 he worked as a scientist and orthopedic surgeon in Sklifovsky Clinical and Research institute for Emergency Care. Since 2017 he has been working in Evdokimov MGSMU Clinical Center.

Participant of conferences and seminars about modern approaches in major joints pathology treatment.

The area of scientific and practical interests is mainly in arthroscopy and various methods of minimally invasive treatment for injuries and diseases of major joints.

In today's fast-paced world it is not easy to maintain a high professional level, to be at the forefront of science and at the same time to critically perceive the new proposed treatment methods. The main credo of professional activity is to believe only trusted scientific sources of information but not bright advertising booklets aimed at gullible patients and doctors.

The author and co-author of more than 35 scientific publications, including 4 patents.