RESUMEN
We describe an independent anterolateral ligament reconstruction technique using the gracilis tendon that can be added to any type of anterior cruciate ligament (ACL) reconstruction procedure. No additional tunnels are drilled. The dual-strand graft is attached to the bone cortex with a nonmetallic, knotless anchor using minimally invasive incisions. For the ACL reconstruction, the semitendinosus is attached to the femur with an ENDOBUTTON and to the tibia with a BioComposite interference screw. The ACL remnant is preserved to improve ligamentization, and the ACL graft is pedicled to the tibia to encourage its vascularization.
RESUMEN
Revision of an anterior cruciate ligament (ACL) reconstruction can be performed as a one-stage or two-stage surgery. Several factors must be taken into consideration when making this choice, especially the size and position of the existing tunnels. When the tibial tunnel is semianatomic, it is difficult to make a new tunnel in the correct position without overlapping the existing tunnel. For this reason, we have developed a one-stage ACL revision surgery that uses a bone allograft plug. When it comes to choosing a reconstruction technique, we believe that combined intra-articular and extra-articular reconstruction with the iliotibial band is suitable when the hamstring tendons are not available, combined with clinical findings of translational and rotational instability. Because the existing tunnels require reorientation, a new femoral tunnel can be created by outside-in drilling to eliminate the risk of overlap, while an allograft bone plug can be used to fill the overly anterior tibial tunnel and allow us to drill the correct tibial tunnel right away. In our hands, this is a safe and effective technique, but longer follow-up is needed to validate its indications.
RESUMEN
BACKGROUND: It has been shown that adding lateral extra-articular tenodesis (LET) to standard anterior cruciate ligament (ACL) reconstruction significantly decreases the loads on the ACL composite graft. To date, the possible effect of LET on ACL graft incorporation is not known. PURPOSE: To compare the incorporation in tibial bone tunnels of a standard quadrupled semitendinosus (ST4) graft to an ST4 graft plus LET at 1 year postoperatively using magnetic resonance imaging (MRI). STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 62 patients who underwent ACL reconstruction were enrolled prospectively: 31 received an ST4 graft, and 31 received an ST4 graft plus LET. Graft incorporation was evaluated with MRI at the 1-year follow-up visit. The following parameters were evaluated: signal-to-noise quotient (SNQ), tibial tunnel widening, graft healing, and graft maturity according to the Howell scale. The primary endpoint was the SNQ of the ST4 graft at 1 year postoperatively; this parameter was adjusted because of unequal baseline characteristics between groups. Clinical and functional outcomes as well as incorporation of the graft were analyzed as secondary endpoints. RESULTS: The mean adjusted SNQ was 0.5 ± 2.1 (95% CI, 0.4-4.6) in the ST4 + LET group and 5.9 ± 3.7 (95% CI, 4.7-7.0) in the ST4 group (P = .0297). The mean tibial tunnel widening was 73.7% ± 42.2% in the ST4 + LET group versus 77.5% ± 46.7% in the ST4 group (P = .5685). Howell grade I, indicative of better graft maturity, was statistically more frequent in the ST4 + LET group (P = .0379). No statistically significant difference was seen between groups in terms of graft healing (P = .1663). The Lysholm score was statistically higher in the ST4 + LET group (P = .0058). No significant differences were found between groups in terms of the International Knee Documentation Committee subjective score (P = .2683) or Tegner score (P = .7428). The mean SNQ of the LET graft at the 1-year follow-up visit was 2.6 ± 4.9. CONCLUSION: At 1 year postoperatively, the MRI appearance of ACL grafts showed generally better incorporation and maturation when combined with LET.