Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2021; 88(6):423-427 | DOI: 10.55095/achot2021/063

Combining ACL Reconstruction and Refixation: the Single Anteromedial Bundle Biological Augmentation and Refixation (SAMBBAR) TechniqueOriginal papers

S. DÖBELE, P. ZIEGLER, V. HOFMANN, T. HISTING, C. KONRADS^*

Department for Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen, Tübingen, Germany

PURPOSE OF THE STUDY:
Anterior cruciate ligament (ACL) preservation surgical techniques have been rising lately. In the acute setting, proximal ACL tears and femoral avulsions of the ACL are good indications for primary repair of the ACL. However, literature shows a wide range of failure rates. An intact synovial membrane seems to be a predicational factor for the outcome of primary ACL repair. Disruption of the synovial membrane is associated with higher failure rates. We describe a surgical technique repairing the ACL in combination with a semitendinosus augmentation for proximal ACL tears with or without disruption of the synovial membrane.

MATERIAL AND METHODS:
The procedure preserves as much of the original anatomy as possible by repairing the synovial membrane and ACL remnant to the femoral origin. To accomplish this, we have built on the so-called "Single Anteromedial Bundle Biological Augmentation (SAMBBA) technique" and developed it further to the "Single Anteromedial Bundle Biological Augmentation and Refixation (SAMBBAR) technique", which we firstly describe here.

RESULTS:
All three patients treated with the SAMBBAR technique showed very good short-term clinical outcomes comparable with successful standard ACL reconstruction. There were no complications. Twelve months postoperatively, patients had no pain. They had normal range of motion in the affected knee without any signs of instability.

DISCUSSION:
The SAMBBAR technique seems to be an adequate procedure to preserve as much proprioceptive native tissue as possible, while at the same time ensuring high tissue strength in order to reduce failure rates. Prospective randomized controlled trials are needed to compare the new SAMBBAR technique with standard ACL reconstruction, with the original SAMBBA technique, and with techniques of ACL refixation.

CONCLUSIONS:
With the presented surgical procedure, it is possible to perform a standard ACL reconstruction using an autologous semitendinosus graft and at the same time preserving the tissue remnant of the ACL in all proximal tear patterns. This might contribute to improved proprioception and rehabilitation without sacrificing stability.

Keywords: anterior cruciate ligament, Lachman test, Ligamys, knee instability, semitendinosus tendon

Published: December 15, 2021  Show citation