[Intrafix fixation and remnants preservation in single-tunnel double-bundle reconstruction of anterior cruciate ligament with anatomical placement of hamstring tendons].
OBJECTIVE
To study the feasibility and short-term effects of Intrafix fixation and remnants preservation in single -tunnel double-bundle reconstruction of anterior cruciate ligament (ACL) with anatomical placement of hamstring tendons.


METHODS
From August 2011 to November 2011, 25 patients with ACL injuries were treated with arthroscopic reconstruction of ACL using hamstring tendon. There were 19 males and 6 females, with a mean age of (26.26 +/- 9.53) years (ranged, 16 to 50 years). Fifteen patients had injuries in left knees, and 10 patients had injuries in right knees. The duration of the disease ranged from 1 to 60 d, with a mean of 9.6 d. All patients with acute injuries had swelling and pain on the knee, and anterior drawer test showed positive results in 14 cases, Lachman test showed positive results in 17 cases. Among patients with old injuries, 5 patients had knee joint pain, 5 patients had unstability of knee joint, 5 patients had positive results of anterior drawer test, and 5 patients had positive results of Lachman test. The diagnosis of ACL injury was determined by the anterior drawer test and Lachman test. There were 20 patients with acute injuries and 5 patients with old injuries. MRI was performed in all patients to confirm the diagnosis of ACL injuries and provide additional information on meniscal and other ligament injuries. Preservation of the remnants was through patellar tendon portal using meniscus suture guide. The femoral tunnel was placed at lateral femoral condyle at 2:00 or 10:00 position through the anteromedial (AM) portal with the knee flexed to 120 degree using an offset guide (DePuy Mitek). The tibia tunnel was placed at the center of the ACL remnant through the AM portal using a tibia guide set 45 degree. The AM and PL bundles were rotated by rotating the positioning tool to achieve the desired positions of the bundles and were fixed by femoral Intrafix and tibia Bio-Intrafix fixation. The anterior drawer test, Lachman test and Lysholm scores were observed to determinate the function of the knee and the activity of the patients.


RESULTS
All the patients were followed up, and the duration ranged from 12 to 18 months. The Lysholm scores improved from preoperative 34.08 +/- 7.60 (25 to 49 scores) to 94.52 +/- 2.86 (89 to 98 scores) at the follow-up time (t = 21.29, P < 0.01). No postoperative complications such as synovitis, ligament rupture and movement restriction occurred.


CONCLUSIONS
Intrafix fixation and remnants preservation in single-tunnel double-bundle reconstruction of ACL with anatomical placement of hamstring tendons is simple, effective, useful, reproducible, and gives a satisfactory short-term results.
Department of Orthopaedics, 174th Hospital of Chinese PLA, Chenggong Hospital Affiliated to Xiamen University, Xiamen 361003, Fujian, China. huangchm123@163.com
Chang-Ming
CM
Huang
Hui-Xiang
HX
Dong
Hua-Qiang
HQ
Fan
Yang-Pan
YP
Fu
D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D001182:Arthroscopy; D005260:Female; D006801:Humans; D016268:Internal Fixators; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D013710:Tendons / Q000601:surgery*; D055815:Young Adult