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Fink C, Smigielski R, Siebold R, Abermann E, Herbort M. Anterior Cruciate Ligament Reconstruction Using a Ribbon-Like Graft With a C-Shaped Tibial Bone Tunnel. Arthrosc Tech 2020; 9:e247-e262. [PMID: 32099779 PMCID: PMC7029192 DOI: 10.1016/j.eats.2019.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/07/2019] [Indexed: 02/03/2023] Open
Abstract
According to recent anatomic studies, the anterior cruciate ligament (ACL) appears to be a flat, "ribbon-like" structure, with a thin, oval-shaped insertion on the femur and a C-shaped tibial insertion. According to this anatomy, we describe an ACL-reconstruction technique that aims to approximate this natural anatomy. The basic principle of this technique is not to use conventional round tunnels but create tunnel shapes that resemble more closely the original ACL insertion sites. Using either a rectangular quadriceps tendon graft or a "flat" hamstring graft may not only provide a biomechanical advantage with increased rotational stability but also improve bone-tendon healing due to increased bone-tendon contact and decreased diffusion length. Creating a C-shaped tibial tunnel also avoids laceration of the anterior horn of the lateral meniscus, which is frequently harmed during conventional tibial tunnel drilling.
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Affiliation(s)
- Christian Fink
- Gelenkpunkt–Sports and Joint Surgery, Innsbruck, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention, UMIT, Hall, Austria
| | | | | | - Elisabeth Abermann
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention, UMIT, Hall, Austria
- Tauernklinikum Zell am See/Mittersill GmbH, Austria
| | - Mirco Herbort
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention, UMIT, Hall, Austria
- OCM Clinic, Munich, Germany
- Address correspondence to Mirco Herbort, M.D., Prof., OCM Clinic, Steinerstrasse 6, 81477 Munich, Germany.
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Fink C, Lawton R, Förschner F, Gföller P, Herbort M, Hoser C. Minimally Invasive Quadriceps Tendon Single-Bundle, Arthroscopic, Anatomic Anterior Cruciate Ligament Reconstruction With Rectangular Bone Tunnels. Arthrosc Tech 2018; 7:e1045-e1056. [PMID: 30377585 PMCID: PMC6203691 DOI: 10.1016/j.eats.2018.06.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/26/2018] [Indexed: 02/03/2023] Open
Abstract
Many surgeons use quadriceps tendon (QT) graft for anterior cruciate ligament (ACL) revision surgery; however, despite excellent clinical results, the QT has not achieved universal acceptance for primary ACL reconstruction. One of the reasons for this may be that the QT is technically demanding to harvest and the scar from open harvesting techniques is less cosmetically favorable than that from hamstring tendon techniques. Recent evidence has suggested that broad flat QT grafts may more closely mimic native ACL "ribbon-like" morphology than hamstring tendon grafts. Furthermore, rectangular bone tunnels may more accurately re-create native ACL attachments, allowing grafts to simulate native ACL rotation during knee flexion and potentially improving biomechanics. Rectangular tunnels have further advantages in revision cases, in which-in comparison with round tunnels-they have reduced overlap with pre-existing transtibial tunnels, increasing the chance of bypassing primary tunnels during revision surgery. Finally, instrumentation for minimally invasive QT harvesting has reduced technical difficulty and improved cosmetic results. Hence, technical and cosmetic concerns are no longer barriers to QT use. These anatomic and biomechanical advantages and technical developments make the QT an increasingly attractive option for both primary and revision ACL reconstruction.
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Affiliation(s)
- Christian Fink
- Gelenkpunkt–Sports and Joint Surgery, Innsbruck, Austria,Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Institute for Sports Medicine, Alpine Medicine and Health Tourism, Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria,Address correspondence to Christian Fink, M.D., Gelenkpunkt–Sports and Joint Surgery, Olympiastrasse 39, 6020 Innsbruck, Austria.
| | - Robert Lawton
- Gelenkpunkt–Sports and Joint Surgery, Innsbruck, Austria,Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Institute for Sports Medicine, Alpine Medicine and Health Tourism, Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | | | - Peter Gföller
- Gelenkpunkt–Sports and Joint Surgery, Innsbruck, Austria
| | - Mirco Herbort
- Department of Trauma, Hand and Reconstructive Surgery, Westfälian-Wilhelms University of Münster, Münster, Germany
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Arthroskopische VKB-Ersatzplastik mit BPTB-Transplantat in Press-fit-Technik. ARTHROSKOPIE 2013. [DOI: 10.1007/s00142-012-0716-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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