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Archives of Orthopaedic and Trauma Surgery

Published in:

01-11-2008 | Arthroscopy and Sports Medicine

Double bundle revision of a malplaced single bundle vertical ACL reconstruction: ACL revision surgery using a two femoral tunnel technique

Authors: Thore Zantop, Wolf Petersen

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 11/2008

Abstract

Background

Several factors influence the outcome after ACL reconstruction. One of the most important factors influencing the resulting knee kinematics and subjective instability is femoral tunnel placement. Revision can be necessary if the femoral tunnel is drilled transtibial in the roof of femoral notch (mismatch).

Hypothesis

Double bundle reconstruction using two femoral tunnels and one tibial tunnel technique can be used in revision of a primary vertical ACL reconstruction.

Study design

Case series (level of evidence III).

Methods

ACL revision was performed in five patients complaining instability after primary transtibial ACL reconstruction. Clinical examination, X-ray and CT analysis were performed to evaluate objective knee laxity, tunnel placement and widening. In all patients a technique using two femoral tunnels in a two medial portal technique and one tibial tunnel was used. Patients were reevaluated at a follow up of 24 months.

Results

Preoperatively, pivot shift tests were 2+ in three and 1+ in the remaining two patients. Lachman test was found to be positive in all patients (4 patients, 2+ firm endpoint; 1 patient, 2+ soft endpoint). X-rays showed a femoral tunnel position at 11.30 (1 patient) and 12.00 o’clock (4 patients). In one patient significant tibial tunnel enlargement was to be found. At a follow up of 24 months, KT 1000 was <2 mm side to side difference and the pivot shift test was negative in all patients.

Conclusion

Revision of a primary vertical ACL reconstruction can be safely performed using a double bundle reconstruction with two femoral tunnels in a two medial portal technique and one tibial tunnel technique. The femoral tunnel need to be located in the anatomic origin of the AM and PL bundle.

Clinical relevance

Femoral tunnel placement in the notch of the intercondylar notch should be avoided. In these cases without significant tunnel enlargement, a primary double bundle revision with two femoral and one tibial tunnel can be performed.

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Title: Double bundle revision of a malplaced single bundle vertical ACL reconstruction: ACL revision surgery using a two femoral tunnel technique
Authors: Thore Zantop
Wolf Petersen
Publication date: 01-11-2008
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 11/2008
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-007-0504-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Double bundle revision of a malplaced single bundle vertical ACL reconstruction: ACL revision surgery using a two femoral tunnel technique

Abstract

Background

Hypothesis

Study design

Methods

Results

Conclusion

Clinical relevance

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Hypothesis

Study design

Methods

Results

Conclusion

Clinical relevance

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