Journal homepage: journal homepage: http://www.elsevier.com/locate/CJTEE
Purpose:
To avoid potential problems of double-bundle anterior cruciate ligament reconstruction (ACLR),
various modifications have been reported. This study analyzed a novel technique of modified doublebundle
(MDB) ACLR without implant on tibial side in comparison to single-bundle (SB) ACLR.
Methods: Eighty cases of isolated anterior cruciate ligament tear (40 each in SB or MDB group) were
included. SB ACLR was performed by outside in technique with quadrupled hamstring graft fixed with
interference screws. In MDB group, ACLR harvested tendons were looped over each other at the center
and free ends whipstitched. Femoral tunnel was created by outside in technique. Anteromedial tibial
tunnel was created with tibial guide at 55. The anatomic posterolateral aiming guide (Smith-Nephew)
was used to create posterolateral tunnel. With the help of shuttle sutures, the free end of gracillis was
passed through posterolateral tunnel to femoral tunnel followed by semitendinosus graft through
anteromedial tunnel to femoral tunnel. On tibial side the graft was looped over bone-bridge between
external apertures of anteromedial and posterolateral tunnel. Graft was fixed with interference screw on
femoral side in 10 knee flexion. International Knee Documentation Committee (IKDC), Tegner score,
Pivot shift and knee laxity test (KLT, Karl-Storz) were recorded pre- and post-surgery. At one year
magnetic resonance imaging (MRI) was done. Statistical analysis was done by SPSS software.
Results: Mean preoperative KLT reading of (10.00 ± 1.17) mm in MDB group improved to (4.10 ± 0.56)
mm and in SB group it improved from (10.00 ± 0.91) mm to (4.80 ± 0.46) mm. The mean preoperative
IKDC score in MDB group improved from (49.49 ± 8.00) to (92.5 ± 1.5) at one year and that in SB group
improved from (52.5 ± 6.9) to (88.4 ± 2.6). At one-year 92.5% cases in MDB group achieved their
preinjury Tegner activity level as compared to 60% in SB group. The improvement in IKDC, KLT and
Tegner scale of MDB group was superior to SB group. MRI confirmed graft integrity at one year and
clinically at 2 years.
Conclusion: MDB ACLR has shown better outcome than SB ACLR. It is a simple technique that does not
require fixation on tibial side and resultant graft is close to native ACL.