Felmet Gernot
ARTICO Sportklinik, Villingen Schwenningen, Germany.
Muscles Ligaments Tendons J. 2012 Apr 1;1(4):148-52. Print 2011 Oct.
The anterior cruciate ligament (ACL) consists of two bundles, the anteromedial (AM) and posterolateral bundle (PM). Double bundle reconstructions appear to give better rotational stability. The usual technique is to make two tunnels in the femur and two in the tibia. This is difficult and in small knees may not even be possible. We have developed a foreign material free press fit fixation for double bundle ACL reconstruction using a single femoral tunnel ((R)). This is based on the ALL PRESS FIT ACL reconstruction. It is suitable for the most common medium and, otherwise difficult, small sizes of knees.
Using diamond edged wet grinding hollow reamers, bone cylinders in different diameters are harvested from the implantation tunnels of the tibia and femur and used for the press fit fixation. Using the press fit technique the graft is first fixed in tibia. It is then similarly fixed under tension in the femoral side with the knee in 120 degree flexion. This is called Bottom To Top Fixation (BTT). On extending the knee the graft tension is self adapting. Depending on the size of the individual knee, the diameter of the femoral bone plug is varied from 8 to 13 mm to achieve an anatomic spread with a double bundle-like insertion. The tibia tunnel can be applied with two 7 or 8 mm diameter tunnels overlapping to a semi oval tunnel between 10 to 13 mm.
Since May 2003 we have carried out ACL-reconstructions with Hamstring grafts without foreign material using the ALL PRESS FIT technique. Initially, an 8 mm press fit fixation was used proximally with good results. Since April 2008, the range of diameters was increased up to 13 mm. The results of the Lachman tests have been good to excellent. Results of the Pivot shift test suggested more stability with femoral broader diameters of 9,5 to 13 mm.
The foreign material free fixation of ham-string in the ALL PRESS FIT Bottom To Top Fixation is a successful method for ACL Reconstruction. The Diamond Instruments and tubed guiding devices are precise, reliable and easy to manage. On this basis a double bundle reconstruction is achieved using a single tunnel. A broad anatomic femoral insertion with autogenous bone plugs inserted near the cortex seems to improve rotational stability.
前交叉韧带（ACL）由两个束组成，即前内侧束（AM）和后外侧束（PM）。双束重建似乎能提供更好的旋转稳定性。常用技术是在股骨和胫骨上各制作两个隧道。这很困难，在小膝关节中甚至可能无法做到。我们已经开发出一种用于双束ACL重建的无异物压配固定方法，使用单个股骨隧道（（R））。这是基于全压配ACL重建技术。它适用于最常见的中等尺寸以及原本困难的小尺寸膝关节。
使用带金刚石刃的湿式磨削空心铰刀，从胫骨和股骨的植入隧道采集不同直径的骨柱用于压配固定。采用压配技术，首先将移植物固定在胫骨上。然后在膝关节屈曲120度时，同样在张力下将其固定在股骨侧。这称为自下而上固定（BTT）。伸展膝关节时，移植物张力会自动适应。根据个体膝关节的大小，股骨骨栓的直径在8至13毫米之间变化，以实现类似双束插入的解剖学展开。胫骨隧道可以采用两个直径为7或8毫米的隧道重叠形成一个10至13毫米的半椭圆形隧道。
自2003年5月以来，我们使用全压配技术进行了无异物的腘绳肌移植物ACL重建。最初，近端使用8毫米的压配固定，效果良好。自2008年4月以来，直径范围增加到13毫米。Lachman试验结果良好至优秀。轴移试验结果表明，股骨直径为9.5至13毫米时稳定性更高。
全压配自下而上固定中腘绳肌的无异物固定是一种成功的ACL重建方法。金刚石器械和带管导向装置精确、可靠且易于操作。在此基础上，使用单个隧道实现双束重建。在皮质附近插入自体骨栓的广泛解剖学股骨插入似乎可提高旋转稳定性。
