Anatomic Double ACL Reconstruction with the Semitendinosus Tendon Only (SS-10)

Abstract

To compare the results obtained with single and anatomic double bundle ACL reconstruction techniques. From 2001 to 2003, 12 patients that were randomly selected underwent anatomic ACL reconstruction with the use of only the semitendinosus tendon. The mean age was 27 years. In these patients, we used the semitendinosus to reconstruct the anteromedial bundle while the gracilis was utilized for the posterolateral bundle. Tibial tunnel was placed within the ACL stump and femoral tunnels at 11 and 10 o’clock respectively with inside-out technique. Femoral fixation was achieved with endobutton CL (Smith and Nephew) while tibial fixation was carried out with staples. Post-operatively, patients underwent a standardized rehabilitation program identical to that carried out for conventional single bundle reconstructions. We then compared our results to a similar group of patients with comparable age, gender, and type of sporting activity that were operated on with a single bundle technique using quadrupled semitendinosus grafts. At a mean follow-up of two years, our results revealed no significant difference in IKDC scores (p<0.05) as 91% of those operated using double bundle and 89% of those with single bundle ACL reconstructions were normal or near normal. Anterior tibial translation as measured by computerized knee arthrometer demonstrated a similar trend with a mean of 1.9 mm for double bundle technique and 1.8 mm for single bundle. In the double bundle group, one patient was documented to have motion deficits (10°-120°) while another patient had impingement. Second-look arthroscopy demonstrated notch impingement whiah was then debrided and partially excised. The short-term clinical outcome and anterior stability data obtained from our preliminary study demonstrated no significant differences between single bundle and double bundle (bi-socket) ACL reconstructions. The apparent advantage that this technique provides in terms of rotational stability remains to be consistently demonstrated as no validated examination technique has yet been established. The use of two separate femoral and tibial tunnels may be more anatomic but technically demanding and probably more prone to surgical errors.