Three-in-One Procedure for Revision ACL Reconstruction

Abstract

Anterior cruciate ligament (ACL) failure following ACL reconstruction happens with many unfavorable causative factors and can result in or exacerbate the unfavorable conditions of the knee in turn [1–3]. Combined ACL and anterolateral structure (ALS) reconstruction has been proved effective to address the unfavorable condition in primary and revision ACL reconstruction [4–6]. In revision ACL reconstruction, the lack of enough graft tissue is of concern when combined ACL and ALS reconstruction is to be performed [7]. The iliotibial band (ITB) is a usable structure to realize lateral extraarticular tenodesis (LET) [8], and part of it can be used as graft tissue to reconstruct the ACL. Thus, for revision ACL reconstruction, we combine the use of free tendon grafts and the ITB to perform ACL and ALS reconstruction, as well as LET, which we name three-in-one procedure. This procedure is indicated to patients who is suitable to one-stage revision ACL reconstruction, and the available grafting tendons is not enough. In primary combined ALS and single-bundle ACL reconstruction [4], in case the six-stranded intraarticular graft made from all three of the semitendinosus tendon (ST), gracilis tendon (GT), and the anterior half of the peroneus longus tendon (AHPLT) is less than 8 mm in size, we also take the current three-in-one procedure as a salvaging technique.