采用自体腘绳肌腱同时行前交叉韧带重建与反向通过的前外侧韧带重建
简介
该技术描述介绍了一种结合反向ACL重建与解剖ALL重建的新术式，采用逆行胫骨半隧道和股骨由外向内钻孔，适用于腘绳肌腱、股四头肌腱或骨-髌腱-骨自体移植物。主要优势在于增强前后向和旋转稳定性、改善移植物-骨界面愈合，并保留髂胫束，适用于年轻运动员、高旋转需求患者及翻修病例。作为技术描述，该术式具有明确的临床指导意义，但尚缺乏长期随访结果验证。
英文摘要
Anterior cruciate ligament reconstruction continues to evolve as surgical techniques aim to optimize graft placement, increase rotational control, and reduce graft failure in high-risk populations. This technical note describes an inverse anterior cruciate ligament reconstruction combined with an anatomic anterolateral ligament reconstruction, incorporating a retrograde tibial half-tunnel and outside-in femoral drilling. The technique is compatible with hamstring, quadriceps tendon, and bone-patellar tendon-bone autografts. Tibial fixation is achieved using a suspensory button that can be directly visualized on the anteromedial cortex, while femoral fixation is performed with an interference screw. The remaining semitendinosus strand or the FiberTape reinforcement is routed beneath the iliotibial band and lateral collateral ligament and anchored at Gerdy's tubercle to anatomically recreate the anterolateral ligament. This procedure is indicated for young athletes, patients with high rotational demands, positive pivot-shift or Jerk tests, primary cases with high rerupture risk, and selected revision scenarios. Advantages of the technique include enhanced anteroposterior and rotational stability, improved graft-bone interface healing through circumferential tunnel contact, preservation of the iliotibial band, minimized morbidity of anterolateral ligament augmentation, and reliable intraoperative visualization of tibial fixation. Additionally, the outside-in femoral approach offers versatility for revision surgery and physeal-sparing application in skeletally immature patients.