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.

Fig. 1

Semi-tendinosus and gracilis tendons were harvested. The tendon's distal part was left attached at their tibial insertion

Fig. 2

Tunnel formation. After the tibial tunnel (8-mm diameter) and the two femoral tunnels (6-mm diameter) were drilled, the graft was looped on the femur, and double fixed using an interference screw and extracortical suture on the periosteum

Fig. 3

Measurement of the width of the tibial and femoral tunnels and record of the cortical bone formation in the tunnels as well as the resorption of the interference screw

Fig. 4

Telos™ radiographs were used to measure anteroposterior tibial translation

Fig. 5

On lateral radiographs, cortical bone formation was recorded in 80% of the anteromedial (AM) and posterolateral (PL) femoral tunnels