Faculty of Comprehensive Rehabilitation, Osaka Prefecture University/Yukioka Hospital, 3-7-30 Habikino, Habikino, Osaka 583-8555, Japan.
Clin Orthop Relat Res. 2012 Mar;470(3):843-52. doi: 10.1007/s11999-011-1948-1.
We developed the rectangular tunnel ACL reconstruction (RT ACLR) using a 10-mm wide bone-patellar tendon-bone (BTB) graft through rectangular tunnels with a rectangular aperture to reduce tunnel size: the cross-sectional area of the tunnels of 50 mm(2) (5 × 10 mm) in RT ACLR is less than that of 79 mm(2) in a conventional 10-mm round tunnel technique presuming the technique would be more suitable in revision ACLR with previous improperly placed tunnels.
Two contiguous 5-mm tunnels inside the anatomic ACL femoral and tibial attachment areas along their long axes, and they are expanded with a 5 × 10-mm dilator into parallelepiped ones.
We indicated and intended to perform the RT ACLR procedure in 31 patients requiring revision between 2004 and 2008. Eighteen of the 31 patients treated with the procedure were followed a minimum of 24 months (mean, 38 months; range, 24 to 73 months). We evaluated ROM, obtained IKDC scores, and determined stability with KT-1000.
The procedure could be applied in 30 of the 31 cases. One of the 18 reruptured the graft at 28 months. Of the remaining 17 patients with followup of 24 months or longer, 15 had full ROM, while the remaining two lost 5° of flexion; 11 were classified as normal and six were nearly normal according to the IKDC evaluation. Stability measured with KT-1000 was 1.0 ± 1.5 mm.
The RT ACLR technique provided acceptable results after one-stage revision ACLR.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
我们通过矩形隧道和矩形开口开发了矩形隧道 ACL 重建（RT ACLR），使用 10mm 宽的骨-髌腱-骨（BTB）移植物，以减少隧道尺寸：RT ACLR 隧道的横截面积为 50mm²（5×10mm），小于传统的 10mm 圆形隧道技术的 79mm²，假设该技术在以前隧道位置不当的 ACLR 翻修中更为合适。
在解剖学 ACL 股骨和胫骨附着区域的长轴上，连续两个 5mm 隧道，并用 5×10mm 扩张器将其扩展为平行六面体。
我们计划在 2004 年至 2008 年间对 31 例需要翻修的患者进行 RT ACLR 手术。18 例接受该手术的患者随访至少 24 个月（平均 38 个月；范围，24 至 73 个月）。我们评估了 ROM，获得了 IKDC 评分，并使用 KT-1000 确定了稳定性。
在 31 例病例中，有 30 例可以进行该手术。18 例中有 1 例在 28 个月时移植物再次断裂。在其余 17 例随访 24 个月或更长时间的患者中，15 例 ROM 完全正常，另外 2 例丢失 5°的屈曲；根据 IKDC 评估，11 例为正常，6 例为接近正常。使用 KT-1000 测量的稳定性为 1.0±1.5mm。
在一期翻修 ACLR 后，RT ACLR 技术提供了可接受的结果。
IV 级，治疗研究。有关证据水平的完整描述，请参阅作者指南。
