title: A new technique in double-bundle anterior cruciate ligament reconstruction with implant-free tibial fixation.
abstract: OBJECTIVE
  This case-series outcome study presents a surgical technique for anatomic double-bundle anterior cruciate ligament (ACL) reconstruction with 4-tunnel using two interference screws. There was a 2-year minimum follow-up.
  
  
  METHODS
  From January to December 2009, an ACL 4-tunnel, anatomic, double-bundle reconstruction was performed on 27 patients. Double-strand hamstring tendon grafts were used in each femoral tunnel as well as two interference screws. Tibial fixation was insured through manual tension, by tying non-absorbable sutures on the bone bridge between the two tunnels at 20° of knee flexion. Clinical assessments included the International Knee Documentation Committee (IKDC) and Lysholm knee scores, range of motion (ROM), pivot-shift test, single-leg hop, and quadriceps-hamstrings strength tests using a hand-held dynamometer. Anterior knee laxity was also assessed using a rolimeter. A single examiner performed all testing pre-operatively at 6 months and during the 2-year follow-up.
  
  
  RESULTS
  All patients were assessed during the 2-year follow-up. At that time, 92 % of the patients presented normal anterior laxity (average, 1.3 ± 0.5 mm) and rotational knee stability. No statistical side-to-side difference was found for ROM, muscle strength, single-leg hop, and function (n.s.). All patients presented a normal knee function according to the IKDC and the Lysholm score. In addition, no infection, graft failure, or pain were observed at the harvesting site.
  
  
  CONCLUSIONS
  The study shows that satisfactory results in relation to knee laxity, function, and strength can be achieved with the implant-free tibial fixation in the ACL double-bundle reconstruction with two interference screws.
  
  
  METHODS
  Therapeutic case series, Level IV.
authors: Clinic of Fractures/Pro-ortopedia, São Paulo, SP, Brazil. pro.ortopedia@uol.com.br.
authors: Sylvio Noronha
authors: SN
authors: Sacramento
authors: Instituto Eduardo Magalhães, São Paulo, SP, Brazil.
authors: Eduardo
authors: E
authors: Magalhães
authors: Habib Medical Center Olaya, Riyadh, Saudi Arabia.
authors: Pascal
authors: P
authors: Christel
authors: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors: Sheila
authors: S
authors: Ingham
authors: Santa Casa de São Paulo School of Medical Sciences (ISCMSP), Centro Universitário São Camilo (CUSC), São Paulo, SP, Brazil.
authors: Thiago Yukio
authors: TY
authors: Fukuda
mesh_terms: D000293:Adolescent; D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000295:instrumentation / Q000379:methods*; D001863:Bone Screws; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: ACL; Knee; Reconstruction; Rehabilitation
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