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

Sohrab Keyhani; Behzad Hanafizadeh; René Verdonk; Mohammadreza Minator Sajjadi; Mehran Soleymanha

doi:10.1055/s-0039-1677812

The Journal of Knee Surgery, Table of Contents

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

Authors

Sohrab Keyhani

¹Department of Knee Surgery and Sports Medicine, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Behzad Hanafizadeh

²Department of Orthopaedic Surgery, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
René Verdonk

³Department of Orthopedics and Traumatology, Ghent University, Ghent, Belgium
Mohammadreza Minator Sajjadi

⁴Research Development Unit, Department of Orthopaedic Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Mehran Soleymanha

⁵Department of Orthopedic Surgery, Orthopaedic Research Center, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran

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

Full Text

References

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