Kan Hiroyuki, Nakagawa Shuji, Arai Yuji, Inoue Atsuo, Hino Manabu, Komaki Shintaro, Takahashi Kenji
Department of Orthopaedics, Kyoto Interdisciplinary Institute of Community Medicine, Kyoto, Japan.
Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Arthrosc Tech. 2022 Nov 18;11(12):e2397-e2401. doi: 10.1016/j.eats.2022.08.047. eCollection 2022 Dec.
After anterior cruciate ligament (ACL) reconstruction, the tibial tunnel becomes widened over time. A revision surgery of the ACL reconstruction is required to fill the widened tunnels. Bone-patellar tendon-bone grafts often are used to fill enlarged bone tunnels. However, due to the variation in tendon length, it is often difficult to adjust the position of the bone fragment to the enlarged part of the bone tunnel. This study describes an arthroscopic ACL reconstruction technique using the semitendinosus tendon as well as a bone fragment which is placed in the enlarged tibial tunnel. The tendon and cortical bone were collected together at the tendon attachment using a flat chisel. The bone fragment was inserted through the tendon in a controlled manner and ultimately placed at the posterior wall of the tibial foramen. This technique was determined to be less invasive than using bone-patellar tendon-bone in a 2-stage revision ACL reconstruction. In addition, this technique can be easily performed by any surgeon who is accustomed to conventional ACL reconstruction using the semitendinosus tendon and does not require any special equipment. Our findings suggest that this technique may be useful for revision ACL reconstruction.
前交叉韧带(ACL)重建术后,胫骨隧道会随着时间推移而变宽。ACL重建翻修手术需要填充变宽的隧道。骨-髌腱-骨移植物常被用于填充扩大的骨隧道。然而,由于肌腱长度存在差异,往往难以将骨块位置调整至骨隧道的扩大部位。本研究描述了一种关节镜下ACL重建技术,该技术使用半腱肌肌腱以及置于扩大胫骨隧道内的骨块。使用平凿在肌腱附着处将肌腱和皮质骨一并采集。骨块以可控方式穿过肌腱,最终置于胫骨骨孔后壁。在两阶段翻修ACL重建中,该技术被确定比使用骨-髌腱-骨的侵入性更小。此外,任何习惯使用半腱肌肌腱进行传统ACL重建的外科医生都能轻松实施该技术,且无需任何特殊设备。我们的研究结果表明,该技术可能对ACL重建翻修有用。