Condyle-Pinching Double-Bundle Anterior Cruciate Ligament Reconstruction

Abstract

The outcomes of anterior cruciate ligament (ACL) reconstruction are still unsatisfactory. Anterolateral ligament (ALL) reconstruction has been applied to augment ACL reconstruction, with better but still nonoptimal results. An anatomical analysis revealed that the route of ALL is quite different from that of ACL on the lateral view of the knee. Thus, we hope to augment ACL reconstruction with the reconstruction of an ACL-mimicking anterolateral structure, in which the route is similar to that of ACL. Thus, we aimed to introduce a combined ACL and ACL-mimicking anterolateral structure reconstruction technique, which we named condyle-pinching double-bundle ACL reconstruction. The main indication of this technique is ACL injury with a high degree of pivot shift or general laxity. The main steps of this technique include preparation of a combined graft, creation of a common femoral tunnel and 2 tibial tunnels, graft placement, and final graft fixation to an adjustable loop. We have been obtaining obvious outcome improvement clinically with this technique and consider that this report will provide special option in ACL reconstruction.

Fig 1

Graft preparation. (A) The semitendinosus tendon (ST), gracilis tendon (GT), and the anterior half of the peroneus longus tendon (AHPLT) are used. (B) The tendons are put together and braided. (C) The tendons are folded at the junction of the middle and lateral one-thirds to form a combined graft. (ACL, anterior cruciate ligament; ALS, anterolateral structure.)

Fig 2

Intra-articular view of the location of the femoral tunnel (right knee viewed from the anteromedial portal). It is located at the center of the ACL footprint. (A) Reference point for location. (B) Created tunnel. (ACL, anterior cruciate ligament.)

Fig 3

Location of the tibial tunnel for ALS reconstruction (right knee). The tibial tunnel for the ALS reconstruction is located at the anterior edge of the lateral tibial plateau, just medial to the Gerdy tubercle. (ALS, anterolateral structure.)

Fig 4

Location of the femoral tunnel (right knee). (A) Outer orifice. (B) Inner orifice. (LFE, lateral femoral epicondyle.)

Fig 5

Placement of the intraarticular graft part (right knee viewed from the anteromedial portal). An obturator is placed under the traction sutures (A) and the graft (B) as a pulley.

Fig 6

Distal suspension fixation of both the ACL and ALS (right knee). The sutures from the grafts are tied to an adjustable loop placed through a transverse tibial tunnel. (ACL, anterior cruciate ligament; ALS, anterolateral structure.)

Fig 7

The routes of ACL and ALS (lateral view of right knee). An obvious angulation between the 2 lines can be found. (ACL, anterior cruciate ligament; ALS, anterolateral structure; LFE, lateral femoral epicondyle.)

Fig 8

Direction of the femoral tunnel (right knee). A femoral tunnel perpendicular to the sagittal plane results in concentric locations of the ACL and ALS insertions. (ACL, anterior cruciate ligament; ALS, anterolateral structure.)

Fig 9

Similar routes of the reconstructed ACL and ALS (right knee) (ACL, anterior cruciate ligament; ALS, anterolateral structure; FH, fibular head.)