Philippe Corentin, Marot Vincent, Courtot Louis, Mesnier Timothée, Reina Nicolas, Cavaignac Etienne
Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France.
I2R, Institut de Recherche Riquet, Toulouse, France.
Arthrosc Tech. 2022 Feb 28;11(3):e463-e469. doi: 10.1016/j.eats.2021.11.019. eCollection 2022 Mar.
Revision of an anterior cruciate ligament (ACL) reconstruction can be performed as a one-stage or two-stage surgery. Several factors must be taken into consideration when making this choice, especially the size and position of the existing tunnels. When the tibial tunnel is semianatomic, it is difficult to make a new tunnel in the correct position without overlapping the existing tunnel. For this reason, we have developed a one-stage ACL revision surgery that uses a bone allograft plug. When it comes to choosing a reconstruction technique, we believe that combined intra-articular and extra-articular reconstruction with the iliotibial band is suitable when the hamstring tendons are not available, combined with clinical findings of translational and rotational instability. Because the existing tunnels require reorientation, a new femoral tunnel can be created by outside-in drilling to eliminate the risk of overlap, while an allograft bone plug can be used to fill the overly anterior tibial tunnel and allow us to drill the correct tibial tunnel right away. In our hands, this is a safe and effective technique, but longer follow-up is needed to validate its indications.
前交叉韧带（ACL）重建翻修术可作为一期或二期手术进行。做出这一选择时必须考虑几个因素，尤其是现有隧道的大小和位置。当胫骨隧道为半解剖型时，很难在不与现有隧道重叠的情况下在正确位置制作新的隧道。出于这个原因，我们开发了一种使用同种异体骨栓的一期ACL翻修手术。在选择重建技术时，我们认为当腘绳肌腱不可用时，结合关节内和关节外使用髂胫束重建，并结合平移和旋转不稳定的临床发现是合适的。由于现有隧道需要重新定向，可以通过由外向内钻孔创建一个新的股骨隧道以消除重叠风险，而异体骨栓可用于填充过于靠前的胫骨隧道，并使我们能够立即钻出正确的胫骨隧道。在我们的操作中，这是一种安全有效的技术，但需要更长时间的随访来验证其适应证。
