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Double-bundle anterior cruciate ligament reconstruction with split Achilles allograft and single tibia tunnel for small ACL tibial footprint : technical note with clinical results

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

We describe a surgical technique of double-bundle ACL reconstruction with a single tibia tunnel and report the clinical outcome.

Methods

The Achilles tendon portion was split longitudinally into two separate bundles, namely, an anteromedial (AM) bundle with 7–8 mm diameter and a posterolateral (PL) bundle with 4–6 mm diameter. The central portion of the calcaneal bone plug was prepared with a diameter of 10 mm and a length of 30 mm. For the femoral tunnel preparation, we preferred inside out target through an accessory anteromedial portal for an approach to native ACL footprint and outside in reaming through separate incision on the lateral aspect of distal thigh to prevent cartilage injury of medial femoral condyle. 10 mm diameter of single tibia tunnel was prepared at the central portion of ACL tibial footprint. After graft passage from tibia to femoral side, fixation of calcaneal bone plug within the tibia tunnel was performed using two bioabsorbable cross pins. Then, AM bundle was first fixed at 45° of flexion while the PL bundle was fixed at 10° of flexion using bioabsorbable interference screws and augmented staples. Clinical results of 22 patients (18 males and 4 females, average age 30.7 years) who underwent double-bundle anterior cruciate ligament (ACL) reconstruction with this technique were evaluated.

Results

At an average follow-up of 30 months, there was significant improvement of the Lysholm knee score, the 2,000 IKDC subjective knee score, the median Tegner activity score and the side-to-side difference. According to the 2,000 IKDC knee examination form, the grade rated as normal in seven patients, nearly normal in 14 patients and abnormal in one patient at the latest follow-up. There were no postoperative complications and revisional surgeries.

Conclusions

Split Achilles allograft and single tibia tunnel technique for double-bundle ACL reconstruction can be an alternative option for patients with small tibial insertion sites.

Level of evidence

Level IV, therapeutic study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Korea University College of Medicine, Anam Hospital Seoul, Seoul, Republic of Korea

    In-Jung Chae, Jinho Jeon & Jong-Hoon Park

  2. Department of Orthopaedic Surgery, Korea University College of Medicine, Ansan Hospital, Gojan 1-Dong, Danwon-Gu, Ansan, Gyeonggi-Do, 425-707, Republic of Korea

    Ji-Hoon Bae

  3. Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Joon-Ho Wang

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  1. In-Jung Chae
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  2. Ji-Hoon Bae
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Correspondence to Ji-Hoon Bae.

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Chae, IJ., Bae, JH., Wang, JH. et al. Double-bundle anterior cruciate ligament reconstruction with split Achilles allograft and single tibia tunnel for small ACL tibial footprint : technical note with clinical results. Arch Orthop Trauma Surg 133, 819–825 (2013). https://doi.org/10.1007/s00402-013-1734-5

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