Anterior Cruciate Ligament Reconstruction Using Hamstrings for a Two-Incision Technique

Abstract

Summary: Anterior cruciate ligament (ACL) reconstructions are most commonly performed through a single incision using either a patellar tendon or hamstring graft. This technique, however, may be problematic in circumstances such as revision ACL reconstructions or reconstructions in patients with open growth plates. In these cases, a second incision may be needed to avoid prior tunnels or an open physis. Severe patellofemoral disorders may also prohibit the use of autologous patellar tendon harvesting. The two-incision ACL reconstruction technique described incorporates a fourstranded semitendinosus-gracilis graft. The four free tendon ends are fixed proximally in a figure-of-eight fashion with two bicortical screws and soft tissue washers, and the distal looped end is secured with three No. 5 sutures tied to a screw and post. This construct provides graft (2800-4500 N) and fixation strengths (821 N) exceeding that of a 10-mm patellar tendon graft with interference screw fixation. This technique allows for an accelerated rehabilitation program, has low graft harvest morbidity, and allows the freedom necessary for tunnel placement and orientation in complicated reconstructions. For these reasons, this technique should be familiar to those surgeons specializing in knee ligament reconstruction.