Outside-In Anterior Cruciate Ligament Revision With Lateral Tenodesis and High-Strength Suture Augmentation Is Easy to Perform With the Iliotibial Band

Vincent Marot,Arnault Valette,Louis Courtot,Thibault Lucena,Nicolas Reina,Etienne Cavaignac

doi:10.1016/j.eats.2021.01.032

Vincent Marot, Arnault Valette + Show 4 more

Open Access

https://doi.org/10.1016/j.eats.2021.01.032

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Abstract

We describe a technique for revision anterior cruciate ligament (ACL) surgery using a 15-cm strip of the iliotibial band as a graft and the gracilis tendon if available. An internal brace is added to augment the graft. The graft is passed through the femur by drilling an outside-in tunnel from the isometric point F9 of Krackow toward the ACL’s footprint and is then double fixed at the tibia using an interference screw and a cortical button. This technique makes it possible to perform simultaneous ACL reconstruction and lateral tenodesis with a continuous, rigid, good-diameter graft that is pedicled to the Gerdy tubercle. Good rotational control is achieved, and all the factors that contribute to ligamentization are present.

Highlights

The retear rate after anterior cruciate ligament (ACL) reconstruction is substantial, ranging from 4.4%1 to 20% in the youngest patients.[2]
Our purpose is to describe a technique for arthroscopic revision after an ACL retear using an iliotibial band (ITB) autograft, augmented by a gracilis autograft if present and an internal brace
Lateral tenodesis is an effective supplement for added rotational control in the setting of ACL revision.[10]

Summary

Surgical Technique

Preoperative Assessment The causes of the retear must be identified among the following: trauma (32%), technical error (improper femoral and tibial tunnel placement, 24%), biological (7%), or a combination of the aforementioned factors (37%).[6]. Single-stage ACL revision can be performed in patients who have appropriately positioned tunnels. If the existing tunnels will be used, the tunnels must be measured to ensure that their diameter does not exceed 15 mm.[7] Two-stage ACL revision reconstruction, with bone grafting, should be performed when tunnel osteolysis is present or if the existing tunnels will overlap with the new tunnels. Limits the risk of tunnel overlap and, of 2-stage revision (Figs 1 and 2). A lateral post proximal to the knee is positioned at the level of the tourniquet, in addition to 2 foot rolls at 90 and 120 of flexion (Fig 3)

Graft Harvesting

Discussion

Findings

Limitations