Combining ACL Reconstruction and Refixation: the Single Anteromedial Bundle Biological Augmentation and Refixation...

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomedical Engineering

Background:

• Anterior cruciate ligament (ACL) preservation surgery is gaining traction.
• Primary repair of proximal ACL tears and femoral avulsions is indicated but shows variable failure rates.
• Synovial membrane integrity is a key factor in primary ACL repair success; disruption correlates with higher failure.

Purpose of the Study:

• To describe a novel surgical technique for repairing proximal ACL tears, including those with synovial membrane disruption.
• To augment primary ACL repair with a semitendinosus graft, enhancing tissue strength and preserving native anatomy.

Main Methods:

• The study presents the 'Single Anteromedial Bundle Biological Augmentation and Refixation' (SAMBBAR) technique, an advancement of the SAMBBA technique.
• The procedure involves repairing the ACL remnant and synovial membrane to the femoral origin, preserving native tissue.
• A semitendinosus autograft is used for augmentation to ensure high tissue strength.

Main Results:

• Three patients treated with the SAMBBAR technique demonstrated excellent short-term clinical outcomes.
• Outcomes were comparable to successful standard ACL reconstruction, with no reported complications.
• At 12 months postoperatively, patients experienced no pain, full range of motion, and no knee instability.

Conclusions:

• The SAMBBAR technique effectively preserves native ACL tissue and enhances strength, potentially reducing failure rates.
• This method may improve proprioception and facilitate rehabilitation without compromising knee stability.
• Further prospective randomized controlled trials are necessary to compare SAMBBAR with other ACL repair and reconstruction techniques.