Outcome of anatomical double-bundle ACL reconstruction using hamstring tendons via an outside-in approach

Abstract

To evaluate the clinical outcome of anatomical double-bundle anterior cruciate ligament (ACL) reconstruction using multistranded hamstring tendons via an outside-in approach. One hundred and twenty-one patients (mean age 28±10years) who underwent ACL reconstruction were examined. Using an outside-in femoral drill guide, an upper femoral tunnel for the anteromedial (AM) graft was created just below the superior articular cartilage margin of the medial wall of the lateral condyle through a small incision. A lower femoral tunnel for the posterolateral (PL) graft was drilled in the centre of the inferior-posterior half of the attachment area behind the resident's ridge in the same manner. Two tibial tunnels were created at the centre of the AM and PL bundle footprints of a normal ACL. Patients were evaluated at 24months postoperatively. According to the IKDC form, 52 knees (43%) were graded as normal, 64 (53%) as nearly normal, 1 (1%) as abnormal and 4 (3%) as graft rupture due to re-injury. Loss of knee extension of <5° was observed in one patient (1%). Among 111 patients who were directly evaluated, none showed loss of flexion of <5°. Lachman sign was negative in 103 patients (93%), while the pivot shift test result was negative or equivalent to that of the contralateral healthy knee in 103 patients (93%). The mean side-to-side difference in anterior laxity at manual maximum force with the KT-2000 arthrometer(®) was 0.9±1.1mm, and 94% of patients showed a range between -1 and +2mm. The anatomical double-bundle outside-in ACL reconstruction provided a satisfactory short-term outcome. Case series, Level IV.