Abstract
Aims and Objectives:
Differentiated gradings of anterior cruciate ligament (ACL) tear-types allow us to perform a more and more differentiated treatment of this injury. Especially in the tears close to the insertion ACL preserving techniques like "healing response" together with growth factors or synthetic augmentations of the original ACL like the "dynamic intraligamentous stabilization DIS" have increasing importance. Disadvantages of the mentioned techniques are the limited indications and the high need of material. That led us to the development of the "transosseous ACL refixation and biological augmentation TARBA", in which the original ACL is refixed to the femoral insertion and augmented with the patient’s doubled gracilis tendon. In the following we will present the first results with this technique.
Materials and Methods:
From 12/2013 to 02/2015 we used this technique in 56 patients (28x m, 28x f, age 30.7years). All patients had ACL tears in the proximal third close to the femoral insertion. The original ACL was fixed arthroscopically with 2 PDS fibres. Those were pulled out of the femur through a 5mm channel. The original-ACL was augmented with a doubled ipsilateral gracilis tendon. This tendon graft was pulled into the joint via another tibial 5mm channel and fixed at the femur with an endobutton and at the tibia with a cortical anchor screw. Both channels were placed exactly adjacent to the centre of the femoral and tibial anatomic insertion sites. The treatment result was controlled after 3, 6, 9 and 12 months with clinical examination and various scores (patient satisfaction, VAS, Lysholm, Tegner, Activity Rating Scale). After 6 months an instrumented stability test (Rolimeter) was performed. All patients were matched with 47 patients who had a complete ACL tear treated with 4-strand stemitendinosus tendon (control group).
Results:
Until now all patients with "TARBA" were satisfied with their operation. The range of motion was equal to the healthy side. Anterior-posterior stability in the Lachman test was equal to the healthy side. Rolimeter-test after 6 months showed an average side difference of less than 1mm. The Pivot-Shift test was 1x positiv in 3 patients. WE had to do 3 revisions (1x traumatic Re-tear, 1x traumatic meniscal tear, 1x limited range of extension). Compared with the control group with complete ACL replacements there was no sicnificant difference in the various scores.
Conclusion:
With "TARBA" the original ACL can be preserved. For augmentation only a rather thin tendon in small channels is "wasted". This new technique shows excellent subjective and objective results within the follow-up period we overlook. If we can prove these findings during the follow-up to come this technique to preserve the native ACL will enlarge the range of treatment options in ACL surgery significantly.