Jaramillo Quiceno Alejandro, Sarmiento Riveros Paula Andrea, Helito Camilo Partezani, Moreira da Silva Andre Giardino, Arias Pérez Rubén Darío, Londoño García Ricardo
Orthopedic and Traumatology Service, North Clinic Foundation, Bello-Antioquia, Colombia.
Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Arthrosc Tech. 2024 Aug 24;14(2):103213. doi: 10.1016/j.eats.2024.103213. eCollection 2025 Feb.
The combination of anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction represents a therapeutic modality that exhibits superior clinical efficacy for certain risk groups when compared with isolated ACL reconstruction. This approach is progressively gaining broader applicability owing to its inherent prospective advantages. Despite the absence of a universally acknowledged gold-standard surgical technique, several methods have been delineated for its implementation. Typically, conventional practice involves the creation of distinct individual tunnels in the femur, followed by graft fixation using interference screws. However, the conventional steps in the technique are not without potential drawbacks. These include tunnel convergence, screw migration, screw irritation, and the risk of lateral collateral ligament injury. The manifestation of such unfavorable outcomes can necessitate a subsequent surgical intervention for effective management. Consequently, adopting a single socket-shaped tunnel strategy for concurrent reconstruction of the ACL and ALL, coupled with femoral fixation using an adjustable-loop button facilitated by a flexible reaming system, presents potential advantages. This alternative approach can mitigate the aforementioned risks by minimizing morbidity and preserving bone stock. The technique is feasible and reproducible, offering a pragmatic avenue for optimizing clinical outcomes in combined ACL and ALL reconstruction.
前交叉韧带(ACL)和前外侧韧带(ALL)联合重建是一种治疗方式,与单纯ACL重建相比,对某些风险群体具有更高的临床疗效。由于其固有的潜在优势,这种方法的适用性正在逐渐扩大。尽管缺乏普遍认可的金标准手术技术,但已经描述了几种实施该方法的方式。通常,传统做法是在股骨中创建不同的单独隧道,然后使用干涉螺钉进行移植物固定。然而,该技术的传统步骤并非没有潜在缺点。这些缺点包括隧道汇聚、螺钉移位、螺钉刺激以及外侧副韧带损伤的风险。这些不良结果的出现可能需要后续手术干预才能有效处理。因此,采用单一的槽形隧道策略同时重建ACL和ALL,并使用由灵活扩孔系统辅助的可调环纽扣进行股骨固定,具有潜在优势。这种替代方法可以通过将发病率降至最低并保留骨量来减轻上述风险。该技术可行且可重复,为优化ACL和ALL联合重建的临床结果提供了一条实用途径。