Rocha de Faria José Leonardo, Pavão Douglas Mello, de Paula Rafael Erthal, Paravidino João Mateus, Laett Conrado Torres, Alexandre Dângelo José de Andrade, Ramallo Daniel, E Albuquerque Rodrigo Sattamini Pires, Maia Phelippe Valente, Mozella Alan de Paula
Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, Brazil.
São Lucas Hospital Copacabana, Rio de Janeiro, Brazil.
Video J Sports Med. 2023 Dec 14;3(6):26350254231206137. doi: 10.1177/26350254231206137. eCollection 2023 Nov-Dec.
Despite advancements in surgical techniques for anterior cruciate ligament (ACL) treatment, persistent functional impairment, reduced quality of life, and limited physical activity participation continue to be common after postoperative rehabilitation. We modify the traditional ACL reconstruction method by using hamstring tendons grafts and re-tensioning them.
This procedure is indicated for patients undergoing ACL reconstruction surgery with soft tissue grafts, utilizing femoral fixation with an adjustable button and tibial fixation with an interference screw.
We employ hamstring grafts for ACL reconstruction and perform femoral fixation using an adjustable button. Initially, we pull the graft approximately 10 mm less than the length of the thickest tunnel drill. This allows for subsequent graft traction after tibial fixation. Following tibial fixation, we pull the graft proximally, inserting it a few millimeters further into the femoral tunnel. This re-tensioning increases tension and enhances physical examination results. In addition, we incorporate the braid graft technique to augment the graft's final thickness.
This technique yields reduced postoperative residual laxity during physical examinations. Our institution's ethics committee is currently reviewing a clinical study comparing functional outcomes with traditional techniques.
DISCUSSION/CONCLUSION: The ACL re-tensioning technique is easily implemented and involves a subtle modification to the traditional approach, allowing for graft re-tensioning and diminishing the risk of residual laxity post-interference screw fixation. This approach acknowledges that insertion of the interference screw can inadvertently reduce graft tension, counteracting the tension applied during fixation. Consequently, this technique is expected to yield superior clinical outcomes.
尽管前交叉韧带（ACL）治疗的手术技术有所进步，但术后康复后持续的功能障碍、生活质量下降以及身体活动参与受限仍然很常见。我们通过使用腘绳肌腱移植物并对其重新张紧来改进传统的ACL重建方法。
本手术适用于采用软组织移植物进行ACL重建手术的患者，股骨固定采用可调纽扣，胫骨固定采用挤压螺钉。
我们采用腘绳肌移植物进行ACL重建，并使用可调纽扣进行股骨固定。最初，我们将移植物牵拉至比最粗隧道钻长度短约10毫米。这便于在胫骨固定后对移植物进行后续牵拉。胫骨固定后，我们将移植物向近端牵拉，将其再插入股骨隧道几毫米。这种重新张紧增加了张力并改善了体格检查结果。此外，我们采用编织移植物技术来增加移植物的最终厚度。
该技术在体格检查时可减少术后残余松弛度。我们机构的伦理委员会目前正在审查一项比较该技术与传统技术功能结果的临床研究。
讨论/结论：ACL重新张紧技术易于实施，是对传统方法的细微改进，可实现移植物重新张紧并降低挤压螺钉固定后残余松弛的风险。这种方法认识到挤压螺钉的插入可能会无意中降低移植物张力，抵消固定过程中施加的张力。因此，预计该技术将产生更好的临床结果。
