Barrett Gene R, Brown Taylor D
Mississippi Sports Medicine and Orthopedic Center, Jackson, Mississippi 39202, USA.
Arthroscopy. 2007 Jul;23(7):796.e1-4. doi: 10.1016/j.arthro.2006.10.025. Epub 2007 Feb 14.
Bone defects are a common obstacle to successful revision anterior cruciate ligament (ACL) reconstruction. We describe the use of a synthetic bone graft plug to fill a cylindric defect after femoral interference screw removal. During revision ACL reconstruction performed through a 2-incision technique, we placed an outside-in guidewire for a new femoral tunnel that converged with the femoral screw from the primary ACL reconstruction. The screw was removed, and the resultant defect appeared very similar to the cylindric bone defect left after an osteochondral graft harvest. The confluence of the defect and the planned femoral tunnel would have allowed a "windshield wiper" effect of the graft at the lateral wall of the notch. We filled the screw defect with a synthetic bone graft plug to limit the aperture size of the femoral tunnel and to buttress the tendinous portion of the revision ACL graft, while maintaining proper anatomic graft position. In this article, we present a readily available all-arthroscopic option for repairing cylindric bone defects without the risk of an allograft or the morbidity of an autograft for a single-stage revision ACL reconstruction.
骨缺损是前交叉韧带（ACL）翻修重建成功的常见障碍。我们描述了在取出股骨挤压螺钉后使用合成骨移植栓填充圆柱形缺损的方法。在通过双切口技术进行ACL翻修重建时，我们为新的股骨隧道置入一根由外向内的导丝，该隧道与初次ACL重建时的股骨螺钉通道汇聚。取出螺钉后，所形成的缺损与骨软骨移植取材后留下的圆柱形骨缺损非常相似。缺损与计划中的股骨隧道的交汇处会使移植组织在髁间窝侧壁产生“雨刮器”效应。我们用合成骨移植栓填充螺钉缺损，以限制股骨隧道的孔径大小，并支撑ACL翻修移植组织的腱性部分，同时保持移植组织的正确解剖位置。在本文中，我们提出了一种易于实施的全关节镜手术方案，用于修复圆柱形骨缺损，该方案不存在同种异体移植的风险，也不会因单阶段ACL翻修重建采用自体移植而产生并发症。
