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J Knee Surg 2020; 33(04): 410-416
DOI: 10.1055/s-0039-1677812
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Revision Single-Stage Anterior Cruciate Ligament Reconstruction Using an Anterolateral Tibial Tunnel

Sohrab Keyhani
1   Department of Knee Surgery and Sports Medicine, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,
Behzad Hanafizadeh
2   Department of Orthopaedic Surgery, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,
René Verdonk
3   Department of Orthopedics and Traumatology, Ghent University, Ghent, Belgium
,
Mohammadreza Minator Sajjadi
4   Research Development Unit, Department of Orthopaedic Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,
Mehran Soleymanha
5   Department of Orthopedic Surgery, Orthopaedic Research Center, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
› Author Affiliations
Funding None.
Further Information

Publication History

12 September 2018

16 December 2018

Publication Date:
06 February 2019 (online)

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Abstract

Revision anterior cruciate ligament (ACL) reconstruction is a technically demanding enterprise. Management of widened or previously malpositioned tunnels is challenging and often requires innovative approaches. The purpose of this study was to evaluate the function and clinical results of revision single-stage ACL surgery using an anterolateral tibial tunnel (ALTT). A consecutive series of knees with arthroscopic ACL revision surgery were analyzed prospectively between April 2012 and September 2015. Among the 93 patients presented with revision ACL reconstruction, 25 patients met the study inclusion criteria for the ALTT technique and were followed up for a minimum of 2 years (range: 24–51 months). The clinical results were evaluated by means of the Lysholm score, International Knee Documentation Committee (IKDC) score, and Tegner activity level scale, and the knee stability was assessed by the Lachman test, pivot shift test, and anterior drawer test. Magnetic resonance imaging (MRI) of the index knee before the surgery and 2 years after revision surgery was assessed. The mean IKDC subjective score, mean Tegner activity level scale, and mean Lysholm score significantly improved in all study participants. This study showed that ACL revision surgery with ALTT can reliably restore stability and provide fair functional outcomes in patients with ACL retear. One could expect acceptable lateral tibial tunnel length compared with medial tibial tunnel in classic ACL revision, intact bony surround, and good graft fixation. This technique is clinically relevant in that making an anterolateral tunnel in one-stage ACL revision surgery had a good subjective result with low complication rate in midterm follow-up.

Keywords

anterior cruciate ligament - revision anterior cruciate ligament reconstruction - anterolateral tibial tunnel - single-stage

Ethical Approval

This study was approved by the Akhtar Hospital Research Ethic Committee in Tehran, Iran (No. 759).


Authors' Contributions

Developing the original idea and the protocol: S. K.


Definition of intellectual content: S. K.


Contribution to the development of the protocol: B. H. and M. M. S.


Study supervision and preparation of the manuscript: R. V.


Preparation and drafting of the manuscript: M. S.


Note

Informed consent was obtained from all individual participants included in the study.