Two-bundle anterior cruciate ligament reconstruction with eight-stranded hamstring tendons: four-tunnel technique

The purpose of this study was to evaluate the clinical results of two bundle anterior cruciate ligament reconstruction with eight strands of hamstring tendons. Forty three cases of chronic anterior cruciate ligament ruptures were reconstructed arthroscopically with eight strands of hamstring tendons in way of two-bundle and four-tunnel reconstruction. Quadruple-stranded semitendinosus tendon was used to reconstruct the anterior bundle, and quadruple-stranded gracilis tendon was used to reconstruct the posterior bundle. The grafts were fixed with a suspension technique by mini-plates and mini-buttons. The patients were followed up for more than one year. Forty one patients (95.3%) had negative Lachman test, and on KT-1000 examination (25 degrees flexion and 30 lb) the side-to-side difference in anterior laxity was <3 mm. One patient had a one plus clinical Lachman's test and another two plus (KT-1000 side-to-side difference of 4 mm and 6 mm respectively). The pivot shift was negative in all but two cases which were one plus. According to the IKDC knee examination form, 42 cases (97.7%) were graded normal or nearly normal. According to the IKDC subjective knee evaluation form, the results increased from 41.4+/-6.3 preoperatively to 95.7+/-3.1 at the last follow-up (P<0.01). The Lysholm score increased from 48.2+/-6.4 to 94.1+/-2.5 (P<0.01). The average Tegner score was 6.9 before injury, 3.5 before surgery and 6.5 at the last follow-up. In conclusion, arthroscopic two-bundle anterior cruciate ligament reconstruction with eight strands of hamstring tendon can reliably restore knee stability.