Surgical technique of ACL augmentation

Abstract

Remnants of ACL have been reported to promote recovery of proprioceptive functions in a graft, resulting in the technique of ACL augmentation becoming accepted widely. We recommend that ACL augmentation is performed in the following cases: ACL remnant retained as a thick ACL remnant bridged between the intercondylar notch and tibia, partial rupture of the PL bundle, and partial rupture of the AM bundle. This procedure is usually performed using the three-portal technique, involving the anterolateral, central anteromedial, and far anteromedial (FAM) portals. The ACL femoral attachment is accessed anatomically through the FAM portal. To make the tibial bone tunnels, guide wires are inserted at the tibial attachment of the ACL remnant and then are over-drilled, making sure that the drill tip does not reach the ACL remnant fibers to minimize damage. Then, a passage is created through the slit made in the ACL remnants. After passing the graft tendon through the slit and checking the length change of the graft during knee flexion, the graft is fixed to the tibia using two staples. Currently, patients undergoing ACL augmentation go through the same postoperative rehabilitation as those undergoing ACL reconstruction.