Dataset Information

Combined Anterior Cruciate Ligament and Posterolateral Corner Reconstruction by Hamstring Tendon Autografts Through a Single Femoral Tunnel by Graft-to-Graft Suspension and Fixation.

ABSTRACT: An untreated posterolateral corner (PLC) injury in patients with a torn anterior cruciate ligament (ACL) may be a leading cause of ACL reconstruction failure. Combined ACL and PLC reconstruction is discussed in few studies in the literature. Femoral tunnel intersection in combined reconstruction has been reported to be high. Short grafts may render combined reconstruction undoable. This Technical Note describes a technique that allows a combined ACL and PLC reconstruction. The ACL graft is a 4-stranded hamstring tendon graft from 1 limb. The PLC graft is a doubled semitendinosus tendon graft from the contralateral side. One femoral tunnel is used connecting the femoral attachment of the PLC on the lateral wall of the lateral femoral condyle to the anatomic femoral ACL footprint on the medial wall of the lateral femoral condyle. The PLC graft is suspended on the ACL graft to be anchored on the cortex of the lateral femoral condyle with added fixation by an interference screw (Arthrex, Naples, FL). The PLC graft limbs are used for open reconstruction of the fibular collateral ligament, popliteus tendon, and popliteofibular ligament. This Technical Note describes a technique of combined ACL and PLC reconstruction with hamstring tendon autografts through a single femoral tunnel using graft-to-graft suspension and fixation.

SUBMITTER: Selim NM

PROVIDER: S-EPMC5984450 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Publications

Combined Anterior Cruciate Ligament and Posterolateral Corner Reconstruction by Hamstring Tendon Autografts Through a Single Femoral Tunnel by Graft-to-Graft Suspension and Fixation.

Selim Naser M NM

Arthroscopy techniques 20180430 5

An untreated posterolateral corner (PLC) injury in patients with a torn anterior cruciate ligament (ACL) may be a leading cause of ACL reconstruction failure. Combined ACL and PLC reconstruction is discussed in few studies in the literature. Femoral tunnel intersection in combined reconstruction has been reported to be high. Short grafts may render combined reconstruction undoable. This Technical Note describes a technique that allows a combined ACL and PLC reconstruction. The ACL graft is a 4-s ...[more]

PMID: 29868435

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Project description:BACKGROUND:The optimal positioning of anterior cruciate ligament graft is still controversially discussed. We therefore wanted to determine the tunnel-to-joint (TJA), tunnel-to-shaft (TSA), and graft-tunnel divergence angles which would provide the best outcome, determined by the KOOS (Knee Injury and Osteoarthritis Outcome Score). This study evaluated the clinical influence of graft orientation as measured with the KOOS questionnaire in patients with anterior cruciate ligament reconstruction with bone-patellar tendon-bone autografts. METHODS:We designed a prospective cohort study, with a 1 ¼ year recruitment phase from March 2011 to July 2012 and a minimal follow-up period of 1 year. Inclusion criteria were patients ??18 years of age receiving an ACL reconstruction with bone-patellar tendon-bone autografts at our institution after having suffered an acute ACL rupture. The primary outcome was the KOOS. Independent variables were patient age, gender, laterality of rupture, mechanism of trauma, and type of femoral and tibial fixation, as well as sagittal graft-tunnel divergence, TJA, and TSA, the latter two being assessed on coronal slices of magnetic resonance imaging. Equations modeling the relationship between TJA, TSA, and graft-tunnel divergence with the KOOS overall score were fitted, and the optimum angles were mathematically determined. RESULTS:In total, 31 patients were included in our study. Our cohort with a median age of 28 years was predominantly male. The mathematically determined optimal placement of the implant in the coronal plane was a TJA of 74.8°, a TSA of 80.1°, and a graft-tunnel divergence angle of 8.5°. CONCLUSION:With regard to patient-reported outcome, the optimal graft orientation is provided by a coronal tunnel-to-shaft angle of 80° and tunnel-to-joint angle of 75°, respectively. Interestingly, in our series, patients reported best clinical outcomes with a sagittal graft-tunnel divergence. These results should be validated in larger studies.

Dataset Information

Combined Anterior Cruciate Ligament and Posterolateral Corner Reconstruction by Hamstring Tendon Autografts Through a Single Femoral Tunnel by Graft-to-Graft Suspension and Fixation.

Publications

Combined Anterior Cruciate Ligament and Posterolateral Corner Reconstruction by Hamstring Tendon Autografts Through a Single Femoral Tunnel by Graft-to-Graft Suspension and Fixation.

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