Brucker Peter U, Lorenz Stephan, Imhoff Andreas B
Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.
Arthroscopy. 2006 Nov;22(11):1250.e1-6. doi: 10.1016/j.arthro.2006.05.024. Epub 2006 Sep 11.
The native anterior cruciate ligament (ACL) consists of 2 bundles, which have distinct biomechanical yet synergistic functions with respect to anterior tibial translation and combined rotatory loads. Traditionally, most ACL reconstruction techniques have primarily addressed the restoration of the anteromedial bundle, and less consideration was given to the posterolateral bundle. Recently, various ACL double-bundle reconstruction techniques have been described. With most of these techniques, however, an indirect extra-anatomic fixation far from the articular surface was performed. Because extra-anatomic fixation techniques, rather than aperture fixation techniques, are associated with graft tunnel motion, windshield wiper action, and suture stretch-out, concerns may arise regarding delayed biological incorporation, tunnel enlargement, and secondary rotational and anterior instability. We, therefore, present a novel arthroscopic technique that reapproximates the footprints of native ACL with the use of double-strand semitendinosus and gracilis autografts for reconstruction of the anteromedial and posterolateral bundles, respectively. A separate femoral and tibial tunnel is drilled for each double-strand autograft. The femoral tunnel for the anteromedial bundle is drilled primarily through a transtibial technique, and the femoral tunnel for the posterolateral bundle is drilled via an accessory anteromedial portal with the use of a 4-mm offset drill guide in the anteroinferior aspect of the femoral tunnel for the anteromedial bundle. Bioabsorbable interference screws are used in aperture fixation for anatomic fixation of each bundle. This technique attempts to reproduce closely the native ligament and its biomechanical function.
天然前交叉韧带（ACL）由2束组成，在胫骨前移和复合旋转负荷方面具有独特的生物力学功能且相互协同。传统上，大多数ACL重建技术主要致力于恢复前内侧束，而对后外侧束的考虑较少。最近，已经描述了各种ACL双束重建技术。然而，对于这些技术中的大多数，在远离关节面的位置进行了间接的非解剖固定。由于非解剖固定技术而非骨隧道固定技术与移植物隧道移动、“雨刮器”动作和缝线拉伸有关，可能会出现关于生物融合延迟、隧道扩大以及继发性旋转和前向不稳定的问题。因此，我们提出了一种新的关节镜技术，该技术使用双股半腱肌和股薄肌自体移植物分别重建前内侧束和后外侧束，从而重新接近天然ACL的足迹。为每根双股自体移植物钻一个单独的股骨和胫骨隧道。前内侧束的股骨隧道主要通过经胫骨技术钻出，后外侧束的股骨隧道通过辅助前内侧入路钻出，在用于前内侧束的股骨隧道的前下方使用4毫米偏移钻导向器。生物可吸收挤压螺钉用于骨隧道固定，以对每一束进行解剖固定。该技术试图紧密重现天然韧带及其生物力学功能。
