Anatomic Double-bundle Reconstruction Using Semitendinosus Tendon

Abstract

For the surgical reconstruction of the anterior cruciate ligament (ACL), a severe challenge is the striking differences in diameter between midsubstance and insertion of the ACL. Both, femoral origin and tibial insertion have an approximately 3 times larger area when compared to the midsubstance. In patients with large insertion sides a single-bundle ACL reconstruction can probably only reflect a compromise restoring only part of the ACL function. Here, a double-bundle (DB) reconstruction can be a good alternative as reconstruction strategy to restore as much of the origin and insertion. This reconstruction can replicate both, anterior and rotational stability of the knee. A well-taken downside of DB reconstruction is the high risk of femoral and tibial tunnel placement. Purpose of the paper is therefore to illustrate the strategy and principles of ACL DB reconstruction with specific aim of providing pitfalls and solutions. This paper describes the technique for an anatomic DB ACL reconstruction using the semitendinosus tendon. In a medial portal approach with a single medial portal, 2 femoral tunnels are located for anteronedial and posterolateral bundle using anatomic femoral aimers. Two tibial tunnels are positioned with regard to the anterior horn of the lateral meniscus with a tibial DB aimer. Using a standardized technique, pitfalls can be avoided and DB reconstruction can be a column in the ACL therapy algorithm.