Keyhani Sohrab, Hanafizadeh Behzad, Verdonk René, Sajjadi Mohammadreza Minator, Soleymanha Mehran
Department of Knee Surgery and Sports Medicine, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Orthopaedic Surgery, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Knee Surg. 2020 Apr;33(4):410-416. doi: 10.1055/s-0039-1677812. Epub 2019 Feb 6.
Revision anterior cruciate ligament (ACL) reconstruction is a technically demanding enterprise. Management of widened or previously malpositioned tunnels is challenging and often requires innovative approaches. The purpose of this study was to evaluate the function and clinical results of revision single-stage ACL surgery using an anterolateral tibial tunnel (ALTT). A consecutive series of knees with arthroscopic ACL revision surgery were analyzed prospectively between April 2012 and September 2015. Among the 93 patients presented with revision ACL reconstruction, 25 patients met the study inclusion criteria for the ALTT technique and were followed up for a minimum of 2 years (range: 24-51 months). The clinical results were evaluated by means of the Lysholm score, International Knee Documentation Committee (IKDC) score, and Tegner activity level scale, and the knee stability was assessed by the Lachman test, pivot shift test, and anterior drawer test. Magnetic resonance imaging (MRI) of the index knee before the surgery and 2 years after revision surgery was assessed. The mean IKDC subjective score, mean Tegner activity level scale, and mean Lysholm score significantly improved in all study participants. This study showed that ACL revision surgery with ALTT can reliably restore stability and provide fair functional outcomes in patients with ACL retear. One could expect acceptable lateral tibial tunnel length compared with medial tibial tunnel in classic ACL revision, intact bony surround, and good graft fixation. This technique is clinically relevant in that making an anterolateral tunnel in one-stage ACL revision surgery had a good subjective result with low complication rate in midterm follow-up.
前交叉韧带（ACL）翻修重建手术技术要求较高。处理增宽或先前位置不当的隧道具有挑战性，通常需要创新方法。本研究的目的是评估使用胫骨前外侧隧道（ALTT）进行单阶段ACL翻修手术的功能和临床效果。对2012年4月至2015年9月期间连续进行关节镜下ACL翻修手术的一系列膝关节进行前瞻性分析。在93例接受ACL翻修重建的患者中，25例符合ALTT技术的研究纳入标准，并进行了至少2年的随访（范围：24 - 51个月）。通过Lysholm评分、国际膝关节文献委员会（IKDC）评分和Tegner活动水平量表评估临床结果，并通过Lachman试验、轴移试验和前抽屉试验评估膝关节稳定性。对手术前和翻修手术后2年的患膝进行磁共振成像（MRI）评估。所有研究参与者的平均IKDC主观评分、平均Tegner活动水平量表评分和平均Lysholm评分均显著改善。本研究表明，采用ALTT进行ACL翻修手术能够可靠地恢复稳定性，并为ACL再撕裂患者提供良好的功能结果。与经典ACL翻修术中的胫骨内侧隧道相比，可预期获得可接受的胫骨外侧隧道长度、完整的骨质周围结构以及良好的移植物固定。该技术具有临床相关性，因为在单阶段ACL翻修手术中制作前外侧隧道在中期随访中具有良好的主观结果和较低的并发症发生率。
