title: Anterior cruciate ligament reconstruction using compressed bone-hamstring-bone graft.
abstract: Strong initial fixation of the graft is essential for successful early rehabilitation before full graft incorporation. The modified bone-hamstring-bone (BHB) composite graft procedure is a hybrid method that lacks the disadvantages of the bone-patellar tendon-bone and semitendinosus and gracilis tendon methods while retaining the advantages of these methods. We describe the modified BHB composite graft procedure used by our surgical team. Two cancellous bone cylinders, 2 cm long and 8 mm in diameter, were taken out of the tibial tunnel and fixed to both ends of the graft by use of sutures. One end of the graft was put into a pressing device to achieve a graft diameter of 9 or 10 mm, and then the other end was pressed. By doing so, very strong end parts of the graft were obtained. The graft was then passed through the tibia into the femoral socket, and once the graft had been properly positioned in the tunnel, it was fixed with round cannulated interference screws (RCI; Smith & Nephew Endoscopy, Andover, MA). This technique of BHB graft preparation allows precise and strong early fixation, promotes biologic fixation, and does not cause patellofemoral joint disorders.
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Institute of Surgery, Clinical Center, Medical School, University of Novi Sad, Novi Sad, State Union of Serbia and Montenegro. milankom@eunet.yu
authors.forename: Miroslav
authors.initials: M
authors.lastname: Milankov
authors.forename: Natasa
authors.initials: N
authors.lastname: Miljkovic
authors.forename: Drgan
authors.initials: D
authors.lastname: Savic
mesh_terms: D016118:Anterior Cruciate Ligament / Q000601:surgery*; D001182:Arthroscopy / Q000379:methods*; D001696:Biomechanical Phenomena; D016025:Bone Transplantation / Q000379:methods*; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D018482:Muscle, Skeletal / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods; D012680:Sensitivity and Specificity; D013314:Stress, Mechanical; D013718:Tensile Strength; D013977:Tibia / Q000637:transplantation; D020858:Tissue and Organ Harvesting / Q000379:methods; D014945:Wound Healing / Q000502:physiology