title: Outcome of anatomical double-bundle ACL reconstruction using hamstring tendons via an outside-in approach.
abstract: OBJECTIVE
  To evaluate the clinical outcome of anatomical double-bundle anterior cruciate ligament (ACL) reconstruction using multistranded hamstring tendons via an outside-in approach.
  
  
  METHODS
  One hundred and twenty-one patients (mean age 28 ± 10 years) 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 24 months postoperatively.
  
  
  RESULTS
  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 ± 1.1 mm, and 94 % of patients showed a range between -1 and +2 mm.
  
  
  CONCLUSIONS
  The anatomical double-bundle outside-in ACL reconstruction provided a satisfactory short-term outcome.
  
  
  METHODS
  Case series, Level IV.
authors.affiliation: Department of Orthopaedics, Osaka Rosai Hospital, 1179-3, Nagasonecho, Kitaku, Sakai, Osaka, 591-8025, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Amano
authors.forename: Yukiyoshi
authors.initials: Y
authors.lastname: Toritsuka
authors.forename: Ryohei
authors.initials: R
authors.lastname: Uchida
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Mae
authors.forename: Kenji
authors.initials: K
authors.lastname: Ohzono
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; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012421:Rupture; D013710:Tendons / Q000637:transplantation*; D016896:Treatment Outcome; D055815:Young Adult