A new technique in double-bundle anterior cruciate ligament reconstruction using implant-free femoral fixation.
OBJECTIVE
The study is a prospective case-series analysis to demonstrate a new double bundle technique for anterior cruciate ligament (ACL) reconstruction with the use of hamstring tendons through a single tibial tunnel, a double femoral socket with implant-free femoral fixation and interference screw for tibial fixation.


METHODS
Twenty-one patients were treated with the same technique. Hamstring tendons were not removed from the tibial side, and using a single tibial and a double femoral tunnel of 8 and 6 mm, respectively, anatomic ACL reconstruction was performed. Graft passage was performed from the tibial side to the posterolateral femoral tunnel and was looped back to the anteromedial femoral tunnel to be fixed on the tibial tunnel with an interference screw and additional extracortical fixation. Follow-up of the study group was performed for a two-year period, documenting standard clinical and radiographic parameters.


RESULTS
Post-operative follow-up (mean 24 months) revealed radiological widening of tibial tunnel (mean 133.6%) in all patients and minor femoral tunnels widening (119.4% and 117.5%). Clinical evaluation showed no signs of instability, and knee evaluation using the IKDC score was performed.


CONCLUSIONS
The manuscript describes a novel technique in ACL reconstruction, and reports the radiographic results of tunnel widening and clinical scores. Implant-free femoral fixation led to minor tunnel widening similar to previously published data. Further studies need to be performed to compare the long-term results with different published techniques of cost-effective implant-free ACL reconstruction.
Santa Casa de São Paulo, Faculty of Medical Sciences, São Paulo, Brazil.
Rodrigo Kancelskis
RK
Prado
Panagiotis G
PG
Ntagiopoulos
Patrícia M B
PM
Fucs
Nilson Roberto
NR
Severino
David
D
Dejour
D000328:Adult; D016118:Anterior Cruciate Ligament / Q000503:physiopathology / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D053587:Arthrometry, Articular; D001178:Arthroplasty / Q000009:adverse effects / Q000379:methods*; D001863:Bone Screws; D005260:Female; D005269:Femur / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery; D007718:Knee Injuries / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012421:Rupture; D013709:Tendon Transfer / Q000009:adverse effects / Q000379:methods*; D013710:Tendons / Q000637:transplantation; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult