Double-bundle anatomic anterior cruciate ligament reconstruction using bone-hamstring-bone composite graft

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Sports Medicine

Background:

• The bone-patellar tendon-bone (BPTB) and semitendinosus and gracilis muscle (STG) grafts have limitations in anterior cruciate ligament (ACL) reconstruction.
• A hybrid approach, the bone-hamstring-bone (BHB) graft, aims to combine advantages while mitigating disadvantages of existing methods.

Purpose of the Study:

• To present an innovative modified BHB technique for anatomic ACL reconstruction.
• To address the two distinct bundles of the ACL: the anteromedial and posterolateral bundles.

Main Methods:

• A modified BHB graft was created by folding the gracilis and semitendinosus tendons twice, with tibial bone blocks at each end.
• A single 11-mm tunnel was prepared in the tibia and femur.
• The graft was inserted and twisted 90 degrees (counterclockwise for right knee, clockwise for left) to create distinct anteromedial and posterolateral bundles.
• Bone blocks were secured using two interference screws.

Main Results:

• The modified BHB technique allows for flexible bone plug placement.
• It minimizes the intra-articular graft length.
• The technique successfully recreates the double-bundle structure of the native ACL.

Conclusions:

• The modified BHB technique offers an effective method for anatomic ACL reconstruction.
• This approach preserves the native ACL's double-bundle anatomy.
• It provides a hybrid solution with potential advantages over traditional graft choices.