Comments on CORR article. Surgical Technique. Revision ACL Reconstruction With a Rectangular Tunnel Technique

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The authors of this paper developed the rectangular tunnel ACL reconstruction (RT ACLR) for revision using a 10-mm wide bone-patellar tendon-bone (BTB) graft through rectangular tunnels with a rectangular aperture. The purpose of this tunnel was to reduce tunnel size: a round tunnel that holds a 5 x 10 mm block is more than 50% larger than the rectangular tunnel.

They reported results from RT ACLR in 18 of 31 patients. One of the 18 reruptured the graft at 28 months. Of the remaining 17 patients with followup of 24 months or longer, 15 had full ROM, while the remaining two lost 5° of flexion; 11 were classified as normal and six were nearly normal according to the IKDC evaluation. Stability measured with KT-1000 was 1.0 ± 1.5 mm. From this they concluded that RT ACLR technique provided acceptable results after one-stage revision ACLR.

For the readers, the question is: should I use this technique?  I think that this paper does not really tell us much. For one thing, maybe conventional techniques also provide "acceptable results". There are no controls here, so that question is simply skipped over.

Also, it seems that the question that the authors addressed (how are the results) skips over some more fundamental issues. The RT technique was invented to make it easier to avoid overlap with the tunnels of the index (pre-revision) surgery. The data are how big a role that played in practice was not shared. Also, the RT technique ostensibly makes for a tighter fit. This should lead to better in-growth, perhaps, or greater initial fixation. This too was not tested.

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