A new technique in double-bundle anterior cruciate ligament reconstruction using implant-free femoral fixation

Abstract

Purpose The study is a prospective case-series analysis to demonstrate a new double bundle technique for anterior cruciate ligament (ACL) reconstruction with the use of hamstring tendons through a single tibial tunnel, a double femoral socket with implant-free femoral fixation and interference screw for tibial fixation. Materials and methods Twenty-one patients were treated with the same technique. Hamstring tendons were not removed from the tibial side, and using a single tibial and a double femoral tunnel of 8 and 6 mm, respectively, anatomic ACL reconstruction was performed. Graft passage was performed from the tibial side to the posterolateral femoral tunnel and was looped back to the anteromedial femoral tunnel to be fixed on the tibial tunnel with an interference screw and additional extracortical fixation. Follow-up of the study group was performed for a two-year period, documenting standard clinical and radiographic parameters. Results Post-operative follow-up (mean 24 months) revealed radiological widening of tibial tunnel (mean 133.6%) in all patients and minor femoral tunnels widening (119.4% and 117.5%). Clinical evaluation showed no signs of instability, and knee evaluation using the IKDC score was performed. Conclusion The manuscript describes a novel technique in ACL reconstruction, and reports the radiographic results of tunnel widening and clinical scores. Implant-free femoral fixation led to minor tunnel widening similar to previously published data. Further studies need to be performed to compare the long-term results with different published techniques of cost-effective implant-free ACL reconstruction.

Comparative study between mono-bundle bone-patellar tendon-bone, double-bundle hamstring and mono-bundle bone-patellar tendon-bone combined with a modified Lemaire extra-articular procedure in anterior cruciate ligament reconstruction

“…This strategy was used with the intent to weaken the muscles most used during the preferred sport to a lesser extent, allowing patients to recover in better condition as soon as possible [16]. For the hamstring technique, the femoral fixation needed a double tunnel because of the absence of any fixation device [17], while for the patellar tendon a single-bundle technique was used.…”

“…Double-bundle hamstring loop technique (DBH) [17]: A double-bundle ACL reconstruction is performed under arthroscopy. The semitendinosus and gracilis tendons are harvested maintaining their tibial insertion intact and sutured to each other to make a doublestranded 25-cm long graft.…”

“…For Telos™ stress radiograph interpretation [17,20,21], two lines were drawn on the radiographs tangential to the posterior border of the upper tibial medial and lateral plateaux. Another line was drawn parallel to the above lines and tangential to the most posterior part of each femoral condyle (assuming perfect superimposition of both femoral condyles).…”

Improved outcomes after anterior cruciate ligament reconstruction with quadrupled hamstring autografts and additional bone plug augmentation at five year follow-up

“…In our study, bone plugs were spongy and not compacted at the time of surgery, hence they may not have had an effect in the first months after surgery, i.e. at the time when TW occurs [18,19]. In that instance, TW was the result of stronger mechanical and biological mechanisms [10].…”

A new technique in double-bundle anterior cruciate ligament reconstruction: some concerns

“…The two femoral tunnels were 6 mm in diameter, with a divergence of 6 mm being observed via arthroscopy, but Fig. 5 (in [1]) shows that there is minimal bone bridge between the two femoral tunnels. Two tunnels, in close relation to each other, could cut through the metaphysis, leading to a higher fracture risk [2].…”