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Gabriele Thiebat, Lorenzo Maria Maggioni, Roberto De Pamphilis, Claudio Manzini, Andrea Panzeri, Marco PungitoreGracilis Anatomic Anterolateral Ligament Reconstruction: Technical NoteArthroscopy Techniques, 2025, 103475, ISSN 2212-6287, https://doi.org/10.1016/j.eats.2025.103475.https://www.sciencedirect.com/science/article/pii/S2212628725000441
Abstract: Anterior cruciate ligament reconstruction alone may not adequately address rotational stability in cases with combined anterior cruciate ligament and anterolateral ligament (ALL) injury. The gracilis anatomic anterolateral ligament (GrAAL) reconstruction technique offers an approach that aims to restore rotational stability by anatomically reconstructing the ALL using the gracilis tendon autograft while preserving its native tibial insertion. This procedure requires only a single femoral fixation point, making it a cost-effective and less invasive alternative to other anatomic ALL reconstruction techniques. This technical note outlines the surgical methodology and potential advantages of our approach.
Claudio Legnani, Giuseppe M. Peretti, Lorenzo Maria Maggioni, Enrico Borgo, Vittorio Macchi, Alberto VenturaFavorable outcomes after one-stage anterior cruciate ligament revision surgery using previous bone tunnelsMinerva Orthopedics 2024 June;75(3):177-82DOI: 10.23736/S2784-8469.24.04392-X
Abstract: The aim of this study is to report the clinical outcome of one-stage anterior cruciate ligament (ACL) revision surgery in patients with correct-positioned previous tunnels having a diameter not exceeding 12 mm and without hardware intra-tunnels. The hypothesis is that this surgical approach can improve functional outcomes compared with the preoperative state in selected patients. Among the 68 patients who underwent revision ACL reconstruction of a previously reconstructed ACL between 2008 and 2018, 23 patients met the study inclusion criteria and were retrospectively reviewed. All the operations were performed by a single senior surgeon. Clinical, arthrometric, and functional evaluations were performed. The Tegner, Lysholm, International Knee Documentation Committee (IKDC) Subjective Knee Form were used. Objective evaluation included range of motion, anterior drawer sign, Lachman test, and KT-1000 instrumented laxity testing. Wilcoxon test was utilized to compare the pre-operative and follow-up status. Differences with a P value <0.05 were considered statistically significant. Mean follow-up was 5.1±1.7 years. Mean Lysholm score increased from a preoperative mean of 60.3±3.2 to 84.6±6.6 (P<0.001). Similarly, IKDC subjective score improved from 36.2±3.2 to 80.1±5.0 (P<0.001). Median Tegner activity rating significantly improved from a preoperative median value of 5.0 (range, 3 to 7) to 6.0 (range, 5 to 10; P<0.001). Anterior drawer and Lachman test were clearly improved when compared with preoperative status (P<0.001) as well as the mean side-to-side KT-1000 value which improved from 6.3±1.1 to 1.9±0.8 mm (P<0.001). One case had a subsequent failure of revision due to new trauma occurred 2 years after repeat surgery. No major complications were reported. The present study suggests favorable results for one-stage revision ACL reconstruction using previous tunnels in selected patients. Subjective knee function and knee stability as well as ability to resume sport activities were improved compared to pre-operatory status. Further studies with larger sample sizes are needed to substantiate these findings.
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