Steiner Mark
New England Baptist Hospital, Boston, MA 02120, USA.
Sports Med Arthrosc Rev. 2009 Dec;17(4):247-51. doi: 10.1097/JSA.0b013e3181c0ccf8.
A critical evaluation of anterior cruciate ligament (ACL) reconstruction techniques has revealed that single-bundle grafts placed by conventional transtibial drilling do not provide adequate restraint to translational and rotatory forces. In some knees, this will affect function and possibly contribute to chondral injuries. The method of 2-bundle ACL reconstruction has evolved partly to address these concerns with the premise that greater rotational stability will be provided by 2-bundle grafts. Although the question of what constitutes rotational stability is still debated, the methodology of 2-bundle ACL reconstructions has clearly reinforced the need to center grafts within the native ACL insertions. When the principles of anatomic graft placement are combined with an independent drilling method, then single-bundle grafts can restore physiologic laxity to the knee. A thorough knowledge of the ACL insertions is necessary and an independent drilling method using an anteromedial portal is required. The technique for anteromedial portal drilling requires adjustments to permit knee flexion over 125 degrees when drilling. Grafts positioned in this fashion will tend to lengthen in extension and fixation may be accomplished with the knee in close to full extension.
对前交叉韧带（ACL）重建技术的严格评估表明，通过传统经胫骨钻孔放置的单束移植物不能为平移和旋转力提供足够的限制。在一些膝关节中，这会影响功能，并可能导致软骨损伤。双束ACL重建方法的发展部分是为了解决这些问题，其前提是双束移植物将提供更大的旋转稳定性。尽管关于什么构成旋转稳定性的问题仍存在争议，但双束ACL重建的方法明确强化了将移植物置于天然ACL附着点中心的必要性。当解剖学移植物放置原则与独立钻孔方法相结合时，单束移植物可以恢复膝关节的生理松弛度。必须全面了解ACL附着点，并且需要使用前内侧入路的独立钻孔方法。前内侧入路钻孔技术需要进行调整，以便在钻孔时允许膝关节屈曲超过125度。以这种方式定位的移植物在伸展时往往会延长，并且可以在膝关节接近完全伸展时完成固定。
