Allahabadi Sachin, Fenn Thomas W, Larson Jordan H, Nho Shane J
Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, RUSH Medical College, RUSH University and RUSH University Medical Center, Chicago, Illinois, USA.
Video J Sports Med. 2023 Aug 7;3(4):26350254221150448. doi: 10.1177/26350254221150448. eCollection 2023 Jul-Aug.
Allograft anterior cruciate ligament (ACL) reconstruction, while it may have a higher failure rate in younger and more active populations, continues to serve as a viable graft option for the appropriately indicated patient. Efficient bone-patellar tendon-bone (BTB) allograft preparation is beneficial to reduce operating time and ensure optimal reconstruction with bony fixation.
ACL reconstruction with BTB allograft is indicated for skeletally mature and older patients, patients who are less active and have fewer physical demands, patients who have had previously harvested autograft, circumstances where an autograft harvest is inadequate, patients with multiligament knee injuries, and patients who prefer allograft use.
The central third of the BTB allograft is harvested, aiming for a graft diameter of 10 mm along the tendon. The tibial bone plug is first cut to a length of 25 to 30 mm and width of 10 mm with the saw at a 70° angle to the bone. The patellar bone plug is cut to a length of 25 mm and width of 10 mm with the saw at a 45° angle to the bone. The bone plugs are mobilized, and soft tissue is dissected to free the graft. The graft is trimmed until it fits through a 10-mm sizer on each side. A single hole is created with a k-wire in the patellar bone plug, and a #5 Ethibond suture is passed. On the tibial bone plug, 2 holes are made perpendicular to one another, and a #2 Fiberwire suture is passed through each of these holes. These sutures allow for facilitated graft passage and tensioning. Once the graft is affixed with interference screws, the graft is arthroscopically evaluated throughout range of motion.
ACL reconstruction with BTB allograft provides high success rates in appropriately selected patients. Data demonstrate more optimal mechanical properties by harvesting the central third of the allograft tendon in younger donors. Non-irradiated and less chemically processed grafts are also preferred to optimize biomechanical properties.
DISCUSSION/CONCLUSION: Bone-patellar tendon-bone allograft with 2 bone plugs offers a reliable alternative to other allografts or autografts. Preparing the allograft in a fashion similar to an autograft harvest may increase familiarity with techniques and facilitate surgical efficiency and graft passage.
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.
同种异体前交叉韧带（ACL）重建术，虽然在年轻且活动较多的人群中失败率可能较高，但对于合适的患者仍是一种可行的移植物选择。高效的骨-髌腱-骨（BTB）同种异体移植物制备有助于减少手术时间，并确保通过骨固定实现最佳重建。
BTB同种异体移植物用于ACL重建适用于骨骼成熟及年长患者、活动较少且身体需求较低的患者、先前已取过自体移植物的患者、自体移植物取材不足的情况、膝关节多韧带损伤患者以及更倾向使用同种异体移植物的患者。
获取BTB同种异体移植物的中间三分之一部分，目标是使肌腱的移植物直径为10毫米。首先用锯以与骨面呈70°角的方式将胫骨骨块切成25至30毫米长、10毫米宽。用锯以与骨面呈45°角的方式将髌骨关节面骨块切成25毫米长、10毫米宽。松动骨块，解剖软组织以游离移植物。修剪移植物直至其能通过两侧的10毫米测量器。用克氏针在髌骨关节面骨块上钻一个孔，并穿入一根5号Ethibond缝线。在胫骨骨块上，钻两个相互垂直的孔，并将2号Fiberwire缝线分别穿过每个孔。这些缝线便于移植物穿过和张紧。一旦移植物用挤压螺钉固定，通过关节镜在整个活动范围内对移植物进行评估。
在适当选择的患者中，BTB同种异体移植物进行ACL重建成功率较高。数据表明，在年轻供体中获取同种异体移植物肌腱的中间三分之一部分，其机械性能更佳。未辐照且化学处理较少的移植物也更有利于优化生物力学性能。
讨论/结论：带两个骨块的骨-髌腱-骨同种异体移植物为其他同种异体移植物或自体移植物提供了可靠的替代方案。以类似于自体移植物取材的方式制备同种异体移植物可能会增加对技术的熟悉程度，并提高手术效率和移植物穿过的便利性。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者在提交本出版物时已包含患者的豁免声明或其他书面批准形式。
