McDermott Emily R, Aman Zachary S, Dekker Travis J
Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, Texas, U.S.A.
Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
Arthroscopy. 2024 Feb;40(2):201-203. doi: 10.1016/j.arthro.2023.11.005.
Anterior cruciate ligament reconstruction (ACLR) is among the most common procedures performed by orthopaedic sports medicine surgeons and has inherent challenges due to the complex anatomy and biomechanical properties required to reproduce the function and stability of the native ACL. Awareness of the anatomic and biomechanical factors, including graft selection and tunnel placement, along with graft tensioning and fixation techniques, is vital in achieving a successful clinical outcome. Common techniques for ACLR graft fixation include intratunnel fixation with interference screws, suspensory fixation, or hybrid fixation strategies, along with several supplemental fixation techniques. Interference screw fixation may decrease graft-tunnel motion, tunnel widening, and graft creep and may be performed with metallic, PEEK (polyether ether ketone), or bioabsorbable screws. Suspensory fixation techniques primarily include suture-buttons, anchors, staples, and screws/washers. Suspensory fixation allows adequate biomechanical strength, although some techniques have been linked to increased graft-tunnel motion and potential tunnel widening. Supplemental fixation techniques may be performed in the setting of concerns for adequacy of primary fixation and includes the use of suture anchors, staples, and screw/washer devices. Regardless of the implant chosen for fixation, secure fixation is paramount to avoid displacement of the graft and allow for integration into the bone tunnel and facilitates early postoperative rehabilitation. It is important for orthopaedic sports medicine surgeons performing primary and revision ACLR to be familiar with multiple fixation techniques.
前交叉韧带重建术（ACLR）是骨科运动医学外科医生最常进行的手术之一，由于需要重现天然前交叉韧带（ACL）的功能和稳定性，其解剖结构复杂且生物力学特性特殊，因而存在诸多内在挑战。了解解剖学和生物力学因素，包括移植物选择、隧道定位，以及移植物张紧和固定技术，对于取得成功的临床结果至关重要。ACLR移植物固定的常用技术包括使用干涉螺钉进行隧道内固定、悬吊固定或混合固定策略，以及几种辅助固定技术。干涉螺钉固定可减少移植物与隧道之间的移动、隧道增宽和移植物蠕变，可使用金属、聚醚醚酮（PEEK）或生物可吸收螺钉进行。悬吊固定技术主要包括缝线纽扣、锚钉、吻合钉和螺钉/垫圈。悬吊固定可提供足够的生物力学强度，尽管一些技术与移植物与隧道之间的移动增加和潜在的隧道增宽有关。在对初次固定的充分性存在疑虑的情况下，可采用辅助固定技术，包括使用缝线锚钉、吻合钉和螺钉/垫圈装置。无论选择何种植入物进行固定，牢固固定对于避免移植物移位并使其融入骨隧道以及促进术后早期康复至关重要。对于进行初次和翻修ACLR的骨科运动医学外科医生来说，熟悉多种固定技术很重要。
