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前交叉韧带重建翻修术:双束技术视频

Re-Revision ACL Reconstruction: A Double-Bundle Technique Video.

作者信息

Bohn Camden, Hand Catherine, Chang Joshua, Khazi-Syed Daanish, Gornbein Chase, Moran Thomas, Forsythe Brian

机构信息

Midwest Orthopaedics at RUSH, Chicago, Illinois, USA.

Indiana University School of Medicine, Indianapolis, Indiana, USA.

出版信息

Video J Sports Med. 2025 Aug 12;5(4):26350254251335672. doi: 10.1177/26350254251335672. eCollection 2025 Jul-Aug.


DOI:10.1177/26350254251335672
PMID:40808857
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12344238/
Abstract

BACKGROUND: Anterior cruciate ligament (ACL) tears are a prevalent knee injury, often requiring surgery. While single-bundle reconstruction is the most employed technique for revision procedures, the native ACL consists of 2 anatomic bundles, and the double-bundle reconstruction technique aims to more accurately replicate this native anatomy. This video demonstrates a reproducible method for performing ACL reconstruction (ACLR) utilizing the double-bundle technique. INDICATIONS: Relative indications for revision double-bundle ACLR include revision or re-revision ACLR, previous lateral extra-articular tenodesis (LET), 2 to 3+ pivot shift, normal posterior tibia slope, and large lateral femoral condyles. TECHNIQUE DESCRIPTION: Arthroscopic delineation of the ACL footprint is performed. With a curved, flexible reamer, the anteromedial socket is drilled. The posterolateral socket is reamed secondarily, providing a 2-mm bone bridge separating the 2 femoral tunnels. Two tibial tunnels are drilled under direct arthroscopic visualization. On the back table, a tibialis anterior allograft and bone-patellar tendon-bone allograft are prepared. The posterior bundle graft is initially passed. A cortical button is passed across the femoral cortex, and its position is confirmed. The anteromedial bundle graft is passed secondarily. Femoral fixation is established with a polyether ether ketone (PEEK) interference screw, and both grafts are fixed on the tibial side with a PEEK anchor. Standard closure follows, and the patient is placed in a hinged knee brace locked in extension. RESULTS: A clinical trial including 81 patients with a mean 10.7-year follow-up indicated an 85% survival rate from needing a second revision ACLR when using an allograft. A meta-analysis by Seppänen et al indicated that the double-bundle technique was superior to the single-bundle technique in International Knee Documentation Committee subjective evaluations ( < .05). Another meta-analysis by Dong et al found no statistical difference in clinical outcomes between the single-bundle versus the double-bundle ACLR techniques. DISCUSSION/CONCLUSION: Double-bundle ACLR offers significant anatomic and biomechanical benefits. In the context of re-revision ACLR, the double-bundle method provides additional collagen graft material and enhanced stability, especially in cases where concurrent LET has been performed and the posterior tibial slope remains normal. PATIENT CONSENT DISCLOSURE STATEMENT: 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.

摘要

背景:前交叉韧带(ACL)撕裂是一种常见的膝关节损伤,通常需要手术治疗。虽然单束重建是翻修手术中最常用的技术,但天然ACL由两个解剖束组成,双束重建技术旨在更准确地复制这种天然解剖结构。本视频展示了一种利用双束技术进行ACL重建(ACLR)的可重复方法。 适应症:翻修双束ACLR的相对适应症包括翻修或再次翻修ACLR、既往外侧关节外肌腱固定术(LET)、2至3级以上轴移、正常的胫骨后倾以及大的外侧股骨髁。 技术描述:进行关节镜下ACL足迹的描绘。使用弯曲的柔性铰刀钻出前内侧骨隧道。其次钻出后外侧骨隧道,在两个股骨隧道之间保留2毫米的骨桥。在关节镜直视下钻出两个胫骨隧道。在手术台上,准备好自体胫骨前肌腱和骨-髌腱-骨移植物。首先植入后束移植物。将皮质纽扣穿过股骨皮质,并确认其位置。其次植入前内侧束移植物。使用聚醚醚酮(PEEK)挤压螺钉进行股骨固定,两根移植物在胫骨侧均用PEEK锚钉固定。随后进行标准缝合,患者置于伸直位锁定的铰链式膝关节支具中。 结果:一项纳入81例患者、平均随访10.7年的临床试验表明,使用同种异体移植物时,再次翻修ACLR的生存率为85%。Seppänen等人的一项荟萃分析表明,在国际膝关节文献委员会主观评估中,双束技术优于单束技术(P<0.05)。Dong等人的另一项荟萃分析发现,单束与双束ACLR技术在临床结果上无统计学差异。 讨论/结论:双束ACLR具有显著的解剖学和生物力学优势。在再次翻修ACLR的情况下,双束方法提供了额外的胶原移植物材料并增强了稳定性,特别是在已进行同期LET且胫骨后倾保持正常的情况下。 患者知情同意披露声明:作者证明已获得本出版物中出现的任何患者的同意。如果个体可识别,作者在提交本稿件以供发表时已包含患者的豁免声明或其他书面批准形式。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b191/12344238/50da2f1efe71/10.1177_26350254251335672-img2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b191/12344238/50da2f1efe71/10.1177_26350254251335672-img2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b191/12344238/50da2f1efe71/10.1177_26350254251335672-img2.jpg

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本文引用的文献

[1]
Current trends in anterior cruciate ligament surgery. A worldwide benchmark study.

J ISAKOS. 2023-2

[2]
Double-bundle non-anatomic ACL revision reconstruction with allograft resulted in a low revision rate at 10 years.

Knee Surg Sports Traumatol Arthrosc. 2023-1

[3]
Double bundle ACL reconstruction leads to better restoration of knee laxity and subjective outcomes than single bundle ACL reconstruction.

Knee Surg Sports Traumatol Arthrosc. 2022-5

[4]
ACL Study Group presents the global trends in ACL reconstruction: biennial survey of the ACL Study Group.

J ISAKOS. 2021-11

[5]
Biomechanical comparison of single-bundle versus double-bundle anterior cruciate ligament reconstruction: a meta-analysis.

Knee Surg Relat Res. 2020-3-12

[6]
Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture.

Best Pract Res Clin Rheumatol. 2019-2-21

[7]
Long term results after double and single bundle ACL reconstruction: Is there any difference? A meta - analysis of randomized controlled trials.

Acta Orthop Traumatol Turc. 2019-3

[8]
Prediction of graft length by body height in anatomic double-bundle anterior cruciate ligament reconstruction.

Asia Pac J Sports Med Arthrosc Rehabil Technol. 2018-3-30

[9]
Prospective randomized clinical evaluation of conventional single-bundle, anatomic single-bundle, and anatomic double-bundle anterior cruciate ligament reconstruction: 281 cases with 3- to 5-year follow-up.

Am J Sports Med. 2011-11-15

[10]
The location of femoral and tibial tunnels in anatomic double-bundle anterior cruciate ligament reconstruction analyzed by three-dimensional computed tomography models.

J Bone Joint Surg Am. 2010-6

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