Tan Yong-Yao, James Loh Sir-Young
Changi General Hospital, Singapore.
Arthrosc Tech. 2024 Feb 14;13(5):102940. doi: 10.1016/j.eats.2024.102940. eCollection 2024 May.
In anterior cruciate ligament (ACL) revision cases, the resultant bigger aperture at the tibia footprint can cause graft instability. The increased movement hinders bone-graft integration and leads to graft abrasion. This article describes a technique to optimize graft stability when using a soft tissue graft for ACL revision. The technique is used when there is suspicion of size mismatch between the new tibia footprint aperture and the graft. The first stage involves passing a suture via an anterolateral tibial tunnel connecting with the revision tibia tunnel distal to the tibia footprint aperture. The new graft is subsequently deployed, and the potential discrepancy between graft diameter and aperture is confirmed. The second stage involves placing 2 pulling sutures on the new graft and passing them into the anterolateral tibial tunnel. The tensioned and anchored pulling sutures secure graft stability at the tibia footprint, and the graft distal to that is fixed routinely. The lasso technique stabilizes the new graft at the tibia footprint by tensioning it in a distal and anterolateral direction. For selected cases, this technique enables a 1-stage ACL revision with a soft tissue graft when faced with graft instability at the tibia footprint.
在前交叉韧带（ACL）翻修病例中，胫骨足迹处形成的较大孔径会导致移植物不稳定。运动增加会阻碍骨移植融合，并导致移植物磨损。本文介绍了一种在使用软组织移植物进行ACL翻修时优化移植物稳定性的技术。当怀疑新的胫骨足迹孔径与移植物之间存在尺寸不匹配时，可使用该技术。第一阶段包括通过前外侧胫骨隧道穿入缝线，该隧道与胫骨足迹孔径远端的翻修胫骨隧道相连。随后展开新的移植物，并确认移植物直径与孔径之间的潜在差异。第二阶段包括在新移植物上放置2根牵引缝线，并将它们穿入前外侧胫骨隧道。张紧并固定的牵引缝线可确保移植物在胫骨足迹处的稳定性，其远端的移植物按常规方式固定。套索技术通过在远端和前外侧方向上张紧新移植物，使其在胫骨足迹处稳定。对于选定的病例，当胫骨足迹处存在移植物不稳定时，该技术可实现使用软组织移植物进行一期ACL翻修。
