Groothoff Jonathan D, Villa Richard S, Glover Mark A, Mason Thomas W, Fiegen Anthony P, van der List Jelle P, Waterman Brian R
Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Department of Orthopaedic Surgery and Rehabilitation, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA.
Video J Sports Med. 2025 Feb 25;5(1):26350254241299456. doi: 10.1177/26350254241299456. eCollection 2025 Jan-Feb.
Primary arthroscopic-assisted anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) graft offers excellent long-term results for patients with ACL tears. When concurrent meniscal damage is present, the preferred treatment is repair of the meniscus. However, meniscectomy may be needed, which can result in insufficient meniscal function.
ACL reconstruction performed concomitantly with meniscal allograft transplantation (MAT) is indicated for patients with ACL tears and meniscal insufficiency. This procedure is typically reserved for younger, active patients, such as the 38-year-old woman in this presentation.
The patient was placed in the supine position. The BTB graft was harvested first using a standard medial midline incision. A posterior meniscus root tunnel was drilled, followed by drilling of the femoral tunnel for ACL reconstruction. The tibial tunnel for ACL reconstruction was subsequently created, after which tapping was performed for anterior meniscus root fixation. The meniscal allograft was secured using alternating vertical mattress inside-out sutures. Finally, the BTB graft was passed through the tibial and femoral tunnels.
Outcomes following ACL reconstruction with BTB autograft and MAT are positive, with a 5-year survival between 84% and 91%. ACL reinjury and long-term development of osteoarthritis are the most common complications. In this case, the patient returned to work within 7 months and reported 0 out of 10 pain.
DISCUSSION/CONCLUSION: ACL reconstruction with BTB autograft and concomitant MAT is a viable treatment option for patients with ACL tears in the context of meniscal deficiency.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
采用骨-髌腱-骨（BTB）移植物进行初次关节镜辅助下前交叉韧带（ACL）重建，可为ACL撕裂患者带来优异的长期效果。当同时存在半月板损伤时，首选的治疗方法是半月板修复。然而，可能需要进行半月板切除术，这可能导致半月板功能不足。
ACL重建联合半月板同种异体移植（MAT）适用于ACL撕裂且半月板功能不全的患者。该手术通常适用于年轻、活跃的患者，如此病例中的38岁女性。
患者取仰卧位。首先采用标准的内侧中线切口采集BTB移植物。钻一个后半月板根部隧道，随后为ACL重建钻股骨隧道。接着创建ACL重建的胫骨隧道，之后进行前半月板根部固定的攻丝操作。使用交替垂直褥式内翻缝合固定半月板同种异体移植物。最后，将BTB移植物穿过胫骨和股骨隧道。
采用BTB自体移植物和MAT进行ACL重建后的结果良好，5年生存率在84%至91%之间。ACL再次损伤和骨关节炎的长期发展是最常见的并发症。在此病例中，患者在7个月内恢复工作，疼痛评分为0（满分10分）。
讨论/结论：对于存在半月板缺陷的ACL撕裂患者，采用BTB自体移植物联合MAT进行ACL重建是一种可行的治疗选择。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可被识别，作者已随本投稿包含患者的豁免声明或其他书面批准形式，以供发表。
