Single-Bundle Augmentation for a Partial Tear of the Anterior Cruciate Ligament

Abstract

Given the prevalence of anterior cruciate ligament (ACL) tears in young athletes, it is essential to elucidate and illustrate surgical interventions that return the most favorable outcomes. Although most ACL injuries are full-thickness tears, occasionally either the anteromedial (AM) or posterolateral (PL) bundle is torn in isolation, allowing consideration of an ACL reconstruction or augmentation. Because the ACL-deficient knee has been shown to exhibit less proprioceptive feedback, the preservation of the intact bundle may offer an inherent component of stability. After arthroscopy has confirmed a partial ACL tear, the decision to augment the intact bundle can be made. The technique is adapted from principles of the double-bundle reconstruction such that the graft follows the path of either the native AM bundle or the native PL bundle, depending on the location of the partial tear. We present our surgical technique for ACL AM bundle augmentation with PL bundle reconstruction using a semitendinosus tendon autograft.

Advanced Anterior Cruciate Ligament Repair and Reconstruction Techniques for Different Rupture Types

“…As soon as a single-bundle tear is confirmed ( Fig 6 ), graft harvest of one hamstring tendon (semitendinosus tendon or gracilis tendon) is performed, as previously described. 15 Alternatively, a tibial insertion preservation technique could be conducted. 14 For 6.5mm to 7.5mm graft preparation (considering notch size and to avoid overstuffing), a baseball stitch with FiberWire no.…”

“… 3 Graft harvesting of semitendinosus and gracilis tendon is conducted by default. 15 Graft preparation is then performed as described previously. The graft is trimmed to 8 to 9 mm in diameter using the baseball stitch with no.…”

“Over the Top” Augmentation for Partial Anterior Cruciate Ligament Tears Using Suspension Device for Tibial Fixation

“…The “over the top” pass of the graft is justified by the need to preserve as much ACL intact remnant as possible; it is more difficult to achieve when performing a tunnel on the femur, especially with the inside-out technique. 12 Otherwise, good mid-term outcomes have been published using the “over the top” position for femoral fixation in partial ACL reconstructions. 13 , 14 …”

“…It is frequent to perform the femoral tunnel using an inside-out technique from the anteromedial portal on the footprint of the torn fascicle. 2 , 11 , 12 When using the anteromedial portal, the femoral tunnel is performed with the knee fully flexed; it hampers the view of the ACL's femoral insertion, particularly when a portion of the ACL is preserved. This inside-out technique requires slightly more extensive debridement of the intercondylar notch.…”

Is Remnant Preserving Single Bundle Reconstruction Surgery an Effective Method in Partial Anterior Cruciate Ligament Rupture?

“…Konservatif tedavi ile takip edilen hastalardan %56'lara varan oranlarda komplet ÖÇB yaralanması saptanmaktadır (2). Cerrahi tedavi yöntemleri arasında henüz altın standart tedavi konusunda bir konsensüs sağlanamamış olsa da; tek demet ÖÇB primer onarımı, tek demet ÖÇB rekonstrüksiyonu ve total ÖÇB rekonstrüksiyon yöntemleri tarif edilmiştir (4)(5)(6). Cerrahi tedavi için ise günümüzde en sık tercih edilen iki yöntem remnant koruyucu tek demet rekonstrüksiyon yöntemi ve anatomik ÖÇB rekonstrüksiyonudur (7).…”