Abstract
While ACL reconstruction using single-tunnel and single-bundle techniques generally yields good clinical results, more and more studies are now reporting results that are not entirely satisfactory, as this type of reconstruction only exerts control over forward tibial shifting, not tibial rotation, when activities that exert high functional demands are undertaken. As a result, recent years have seen the appearance of numerous techniques for anatomic ACL reconstruction that reproduce both the anteromedial and posterolateral bundles of the ligament and therefore offer potentially improved rotational control. This article outlines a technique for anatomic ACL reconstruction. Said technique uses central and anteromedial portals, which afford a better perspective of the intercondylar notch. The main features of this technique are: (1) Double bone tunnels in the femur and tibia. The femoral tunnels are created using the out-in technique. (2) Double bundles with hamstring tendon grafts. (3) Tibial fixation by means of interference screws. (4) Femoral fixation in which the graft is supported by a cortical bone bridge and an interference screw in one of the tunnels. We feel that the main advantage of this technique is precisely that it introduces a new feature (a cortical femoral bone bridge) and is not necessarily dependent on specific double-bundle instrumentation, using only regular drill guides to create out-in femoral tunnels. This enables said tunnels to be located with ease and precision. The femoral fixation model itself, with the support provided by the cortical bone bridge, potentially guarantees a level of resistance that can be further increased with the aid of one or two interference screws, thus avoiding the need for post fixation techniques that require the use of screws or buttons.
Similar content being viewed by others
References
Asagumo H, Kimura M, Kobayashi Y (2007) Anatomic reconstruction of the anterior cruciate ligament using double-bundle hamstring tendons: surgical techniques, clinical outcomes and complications. Arthroscopy 23:602–609
Bellier G, Christel P, Colombet P (2004) Double-stranded hamstring graft for anterior cruciate ligament reconstruction. Arthroscopy 20:890–894
Cohen SB, Fu FH (2007) Three-portal technique for anterior cruciate ligament reconstruction: use of a central medial portal. Arthroscopy 23(3):325.e1–325.e5
Espejo A, Urbano V, López R, Montañez E, Queipo de Llano A (1999) Plastia del ligamento cruzado anterior con 4 fascículos de la pata de ganso (anterior cruciate ligament plasty using 4 hamstring bundles). Cuadernos Artrosc 6:23–27
Freedman KB, S’Amato MJ, Nedeff DD (2003) Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med 31:2–11
Girgis FG, Marshall JL (1975) The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop Relat Res 106:216–231
Giron F, Cuomo P, Edwards A (2007) Double-bundle “anatomic” anterior cruciate ligament reconstruction: a cadaveric study of tunnel positioning with a transtibial technique. Arthroscopy 23:7–13
Hwan J, Hak Lee S (2007) Anterior cruciate ligament double-bundle reconstruction with hamstring tendon autografts. Arthroscopy 23:109.e1–109.e4
Järvelä T (2007) Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective, randomized clinical study. Knee Surg Sports Traumatol Arthrosc 15:500–507
Johma NM, Pinczewski LA, Clingeleffer A (1999) Arthroscopic reconstruction of the anterior cruciate ligament with patellar-tendon autograft and interference screw fixation. The results at seven years. J Bone Joint Surg Br 81:775–779
Kim S, Jung K, Song D (2006) Arthroscopic double-bundle anterior cruciate ligament reconstruction using autogenous quadriceps tendon. Arthroscopy 22:797.e1–797.e5
Muneta T, Koga H, Mochizuki T (2007) A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques. Arthroscopy 23:618–628
Nedeff DD, Bach BR Jr (2001) Arthroscopic anterior cruciate ligament reconstruction using patellar tendon autografts: a comprehensive review of contemporary literature. Knee Surg 14:243–258
Petersen W, Zantop T (2006) Anatomy of the anterior cruciate ligament with regard to its two bundles. Clin Orthop Relat Res 454:35–47
Ristanis S, Stergiou N, Patras K (2005) Excessive tibial rotation during high-demand activities is not restored by anterior cruciate ligament reconstruction. Arthroscopy 21:1323–1329
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Espejo-Baena, A., Serrano-Fernandez, J.M., de la Torre-Solis, F. et al. Anatomic double-bundle ACL reconstruction with femoral cortical bone bridge support using hamstrings. Knee Surg Sports Traumatol Arthrosc 17, 157–161 (2009). https://doi.org/10.1007/s00167-008-0642-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-008-0642-7