Anatomical revision ACL reconstruction with rectangular tunnel technique

Abstract

Revision ACL reconstruction (ACLR) is technically difficult because of pre-existing tunnels in the primary ACLR. We developed the anatomical rectangular tunnel ACL reconstruction (ART ACLR) with a bone-patellar tendon-bone (BTB) graft to mimic fiber arrangement inside the native ACL via smaller tunnels. With a 10-mm wide graft, the cross-sectional area of the tunnels of 50 mm2 in ART ACLR is less than that of 79 mm2 in a traditional 10-mm round tunnel procedure, suggesting that tunnel encroachment would be less of a problem at the time of revision ACLR with this novel technique. Thus, the ART ACLR technique could be most frequently applied to the patients suffering from failed nonanatomical primary ACLR. In this chapter, the indication and technical considerations for ART ACLR as one-stage revision ACLR were described.