New anatomical single bundle ACL reconstruction using a rounded rectangular dilator

摘要

Background: During the past 10 years, the main trend for ACL reconstruction has shifted to anatomic reconstruction, regardless of single bundle or double bundle techniques. There is no significant difference in the postoperative stability and clinical results between single and double bundle ACL reconstruction. Therefore, attention has returned to single bundle reconstruction with grafts that are placed at the center of anatomical footprint. It is widely accepted that the smaller hamstring autograft size (tunnel diameter < 8mm) is a predictor of poorer clinical results. However, the shortcoming of conventional anatomical single bundle ACL reconstruction is that the creation of a large anatomical bone tunnel is not possible because of roof impingement or breakage of posterior femoral bone tunnel in small Asian female. Based on the results of many recent anatomical studies involving the ACL, we should create a femoral bone tunnel in a rounded rectangular shape to approximately reproduce the native tendon-bone junction of the ACL and perform ACL reconstruction using a thick graft, and we have also realized that the cross-sectional shape of the fourfold ST graft was not round, but oval. The rounded rectangular tunnel was more fitted to the graft than the round tunnel Therefore, we created an original femoral dilator and sizing block and developed a new ACL reconstruction technique: “rounded rectangular femoral tunnel ACLR” (RFTR). This study aimed to compare the area of femoral tunnel and clinical results between conventional anatomical single bundle ACL reconstruction (ASBR) and RFTR. The hypothesis was that RFTR could have a larger femoral tunnel and improve clinical results.