Helito Camilo Partezani, da Silva Andre Giardino Moreira, Guimarães Tales Mollica, Sobrado Marcel Faraco, Pécora José Ricardo, Camanho Gilberto Luis
Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333 - Cerqueira Cesar, São Paulo, SP, CEP: 05403-010, Brazil.
Hospital Sírio Libanês, Rua Dona Adma Jafet, 91 - Bela Vista, São Paulo, SP, CEP 01308-050, Brazil.
Knee Surg Relat Res. 2022 May 8;34(1):24. doi: 10.1186/s43019-022-00153-3.
Revision anterior cruciate ligament (ACL) reconstructions are usually complex owing to previous tunnels. The objective of this study is to report the results of a revision ACL reconstruction technique with a tibial tunnel performed from the anterolateral plateau associated with an anterolateral ligament (ALL) reconstruction.
Patients with at least two ACL reconstructions that failed and who had significant enlargement and confluence of tunnels in the medial tibial plateau and underwent revision ACL reconstruction associated with ALL reconstruction with the tibial tunnel for the ACL performed from the lateral plateau between 2017 and 2019 were evaluated. All patients were evaluated by physical examination, International Knee Documentation Committee (IKDC), and Lysholm functional scales.
Six patients who underwent this surgical procedure were evaluated. All patients were sports practitioners and presented a grade 3 pivot shift. The mean age was 28.5 ± 8.2 years, and the mean follow-up time was 34.1 ± 12.8 months. No patient had a new graft rupture, but three (50%) had grade 1 pivot shift. Four patients had minor complications with no clinical impact on the final result. All except one patient were able to return to pre-injury type of sports, at a mean time of 14.6 ± 2.3 months after surgery.
The anterolateral tibial tunnel technique using an Achilles tendon allograft for revision ACL reconstruction after multiple failures associated with an ALL reconstruction showed good results and no major complications. The anterolateral tunnel can be considered a good alternative in cases of medial tibial confluence or significant enlargement of the medial tunnels in re-revision procedures.
由于存在既往隧道，翻修前交叉韧带（ACL）重建手术通常较为复杂。本研究的目的是报告一种经前外侧平台建立胫骨隧道并联合前外侧韧带（ALL）重建的翻修ACL重建技术的结果。
对2017年至2019年间至少有两次ACL重建失败、胫骨内侧平台隧道明显扩大且融合，并接受经外侧平台建立胫骨隧道进行ACL重建联合ALL重建的患者进行评估。所有患者均通过体格检查、国际膝关节文献委员会（IKDC）和Lysholm功能量表进行评估。
对6例行该手术的患者进行了评估。所有患者均为运动员，均表现为3级轴移试验阳性。平均年龄为28.5±8.2岁，平均随访时间为34.1±12.8个月。无患者出现新的移植物断裂，但3例（50%）存在1级轴移试验阳性。4例患者出现轻微并发症，对最终结果无临床影响。除1例患者外，所有患者均能在术后平均14.6±2.3个月恢复到受伤前的运动类型。
对于多次失败后联合ALL重建的翻修ACL重建，采用同种异体跟腱经前外侧胫骨隧道技术显示出良好的效果且无重大并发症。在再次翻修手术中，当胫骨内侧隧道融合或明显扩大时，前外侧隧道可被视为一种良好的选择。
