Anatomic double-bundle anterior cruciate ligament reconstruction with hamstrings

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomedical Engineering

Background:

• Anterior cruciate ligament (ACL) injuries are common, often requiring surgical reconstruction.
• Current ACL reconstruction techniques face challenges in fully restoring native ligamentous anatomy and function.
• Anatomic reconstruction aims to replicate the native ACL's bundles for improved biomechanical performance.

Purpose of the Study:

• To describe a hardware-free, double-bundle gracilis and semitendinosus tendon technique for ACL reconstruction.
• To achieve a more anatomic reconstruction that mimics the native ACL's anteromedial and posterolateral bundles.
• To evaluate the potential for improved functional outcomes through a four-bundle reconstruction.

Main Methods:

• Harvesting gracilis and semitendinosus tendons while preserving tibial insertion.
• Creating tibial and femoral tunnels to optimize graft placement for anatomic reconstruction.
• Utilizing a suture-based fixation technique, passing grafts through the knee joint and securing them without hardware.
• Employing an arthroscopic "over-the-top" technique for femoral fixation.

Main Results:

• The described technique allows for hardware-free graft fixation.
• It facilitates the creation of a four-bundle reconstruction, aiming to replicate both native ACL bundles.
• The method prioritizes precise tunnel placement for enhanced graft isometry and congruence.

Conclusions:

• This double-bundle hamstring tendon technique offers a hardware-free option for anatomic ACL reconstruction.
• The four-bundle approach has the potential to improve biomechanical function and clinical outcomes compared to traditional methods.
• Further clinical studies are warranted to validate the long-term efficacy and performance of this technique.