Korean J Sports Med.  2011 Dec;29(2):93-98. 10.5763/kjsm.2011.29.2.93.

Revision Anterior Cruciate Ligament Reconstruction Using Two Anteromedial Portal Technique

• Yoo DS
• Lee BC
• Park JH
• Kim MK

• KMID: 1987188
• DOI: http://doi.org/10.5763/kjsm.2011.29.2.93

Abstract

There are numerous reasons for the failure of anterior cruciate ligament (ACL) reconstruction. Among them, surgical technical failure and wrong femoral tunnel location are the most common. The authors focused on the results of ACL revision using two anteromedial portals. Sixteen patients were selected with two anteromedial portals that were designed to decrease the femoral tunnel slope in sagittal plane. Clinical analysis was carried out based on Lysholm score, Tegner score and International Knee Documentation Committee (IKDC). For anterior stability test, Lachman test, KT-2000 arthrometer were used. pivot shift test was measured for rotatory stability test. Preoperative Lachman test and pivot shift test showed positive finding in all cases, however, postoperative Lachman with 10 cases (62.5%) and pivot shift test with 10 cases (62.5%) were negative. The difference of anterior displacement with the non-affected side using KT 2000 arthrometer showed 6.57 mm (range: 4.0-12.0 mm) preoperatively and 2.20 mm (range: 1.0-4.0 mm) postoperatively on average. Score of Tegner and Lysholm improved from 4.86 (range: 2.0-7.0), 46.14 (range: 33-52) preoperatively, to postoperative score of 8.14 (range: 7.0-9.0), 83.43 (range: 74-89) at the final follow up. IKDC result also showed improvement. ACL reconstruction method using two anteromedial tunnels that is desgined to decrease femoral tunnel slope at sagittal plane is an effective technigue for revision surgery after initial ACL reconstruction failure. This technigue allows superior femoral tunnel selection, firm fixation of grafts and also shows excellent clinical results with stability.

Keyword

Anteromedial portals; Anterior cruciate ligament revision surgery

MeSH Terms

Anterior Cruciate Ligament
Anterior Cruciate Ligament Reconstruction
Displacement (Psychology)
Follow-Up Studies
Humans
Knee
Transplants

Figure

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  Fig. 1. Two anteromedial portal technique. Standard anterome-dial (AM) portal is main viewing portal, just medial to medial margin of patellar tendon. Far medial AM portal is main working portal such as femoral tunnel drilling, not impinged with me-dial femoral condyle.

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  Fig. 2. We can observe better field of knee joint for developing new femoral tunnel. AL: anterolateral, AM: anteromedial.

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  Fig. 3. We removed residual hardware if new femoral tunnel is interfered by hardware.

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  Fig. 4. Coronal obliquity of fem-oral tunnel before and after an-terior cruciate ligament (ACL) revision surgery. Before ACL re-vision surgery, mean angle is 62.3 o. After ACL revision sur-gery, mean angle is 44.6 o.

Reference

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