title: Bi-socket ACL reconstruction using hamstring tendons: high versus low femoral socket placement.
abstract: To clarify the importance of the femoral socket location in bi-socket Anterior cruciate ligament (ACL) reconstruction. Subjects included 261 patients with an average age of 26 years who received ACL reconstruction via the high-femoral socket procedure (Group H) and 43 patients with an average age of 29 years who received ACL reconstruction via the low-femoral socket procedure (Group L) with a minimal follow-up of 24 months. In Group H, the femoral sockets were created at 1:00 or 11:00 and 2:00-2:30 or 9:30-10:00 of the intercondylar notch. In Group L, the two femoral sockets were drilled at 2:00 or 10:00 and 3:00 or 9:00. For the tibial side, a single tunnel was made at the center of the footprint. Evaluation was performed based on the IKDC Knee Examination Form. While 137 knees (52%) were graded as normal, 100 (38%) as nearly normal, 8 (3%) as abnormal, and 2 (1%) as severely abnormal with 14 (5%) re-injury in Group H, 38 knees (74%) were graded as normal, and 7 (16%) as nearly normal with 3 (7%) re-injury in Group L, showing a better subjective evaluation (P = 0.007). The average side-to-side differences in anterior laxity at manual maximum force with the KT-1000 were 1.1 +/- 1.6 mm for Group H and 1.0 +/- 1.6 mm for Group L without statistically significant differences excluding re-injured cases. There were 204 patients (83%) from Group H and 33 (83%) from Group L with values between -2 and 2 mm, while 228 (92%) patients from Group H and 38 (95%) from Group L had values distributed between -3 and 3 mm. While the bi-socket ACL reconstruction provided objectively satisfactory clinical outcomes in more than 90% of the patients, the low-femoral socket placement was found to subjectively achieve better outcomes.
authors.affiliation: Department of Orthopaedic Sports Medicine, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo 660-0064, Japan. toritsuka@kanrou.net
authors.forename: Yukiyoshi
authors.initials: Y
authors.lastname: Toritsuka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Amano
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Yamada
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hamada
authors.forename: Tomoki
authors.initials: T
authors.lastname: Mitsuoka
authors.forename: Shuji
authors.initials: S
authors.lastname: Horibe
authors.forename: Konsei
authors.initials: K
authors.lastname: Shino
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D002648:Child; D005260:Female; D005269:Femur / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D019637:Orthopedic Procedures / Q000379:methods*; D011182:Postoperative Care; D011859:Radiography; D013710:Tendons / Q000637:transplantation*; D013977:Tibia / Q000601:surgery; D016378:Tissue Transplantation / Q000379:methods; D016896:Treatment Outcome