Remnant-preserving, selective single-bundle augmentation of the anterior cruciate ligament using a bone-patellar tendon-bone autograft: A technical note

- This is the first study on anterior cruciate ligament (ACL) augmentation technique using a bone-patellar tendon-bone (BTB) graft.
- This procedure is an available surgical option for ACL partial tear cases, which require very high durability of reconstructed ACL.

BackgroundTo the best of our knowledge, there has been no detailed study on bone-patellar tendon-bone (BTB) grafts for remnant-preserving, selective-bundle anterior cruciate ligament (ACL) augmentation. Therefore, we aimed to develop such a technique using a BTB graft.MethodA total of five patients underwent surgery using the presented procedure. These patients were young, male, and with high body mass index, and hence required very high durability of reconstructed ACL. A femoral bone tunnel was created using the inside-out technique via an accessory far-medial portal, protecting the remnant using a probe, regardless of the presence of an anteromedial (AM) or posterolateral (PL) tunnel. A single tibial tunnel was drilled at the center of the AM or PL attachment and two transverse skin incisions were made in the ipsilateral knee. The central third of the patellar tendon attached to a patellar and tibial bone plug autograft with a width of seven millimeters was harvested by subcutaneous tunneling. The femoral side was fixed using a cortical fixation device for BTB and the tibial bone plug was fixed using an interference screw with the knee at an angle of 20° of flexion by applying maximal manual traction.ResultsBone tunnel enlargement, which was measured by computed digital radiography, was not observed in all cases. A BTB autograft for remnant-preserving, selective-bundle ACL augmentation offers reduced risk of tunnel enlargement.ConclusionThe presented procedure might be considered one of the potentially available options for patients with ACL partial tear who require very high durability of reconstructed ACL.Level of evidence5