A new technique in double-bundle anterior cruciate ligament reconstruction with implant-free tibial fixation.

purposeThis case-series outcome study presents a surgical technique for anatomic double-bundle anterior cruciate ligament (ACL) reconstruction with 4-tunnel using two interference screws. There was a 2-year minimum follow-up.

methodsFrom January to December 2009, an ACL 4-tunnel, anatomic, double-bundle reconstruction was performed on 27 patients. Double-strand hamstring tendon grafts were used in each femoral tunnel as well as two interference screws. Tibial fixation was insured through manual tension, by tying non-absorbable sutures on the bone bridge between the two tunnels at 20° of knee flexion. Clinical assessments included the International Knee Documentation Committee (IKDC) and Lysholm knee scores, range of motion (ROM), pivot-shift test, single-leg hop, and quadriceps-hamstrings strength tests using a hand-held dynamometer. Anterior knee laxity was also assessed using a rolimeter. A single examiner performed all testing pre-operatively at 6 months and during the 2-year follow-up.

resultsAll patients were assessed during the 2-year follow-up. At that time, 92 % of the patients presented normal anterior laxity (average, 1.3 ± 0.5 mm) and rotational knee stability. No statistical side-to-side difference was found for ROM, muscle strength, single-leg hop, and function (n.s.). All patients presented a normal knee function according to the IKDC and the Lysholm score. In addition, no infection, graft failure, or pain were observed at the harvesting site.

conclusionThe study shows that satisfactory results in relation to knee laxity, function, and strength can be achieved with the implant-free tibial fixation in the ACL double-bundle reconstruction with two interference screws. LEVEL OF EVIDENCE: Therapeutic case series, Level IV.