ACL reconstruction with double bundle technique using hamstring tendons: Surgical technique, difficulties and initial results

PURPOSE: Normal ACL consists of two bundles (anteromedial and posterolateral). Each one of them appears to operate at different flexion angles, but both of them cooperate during knee motion, in a different percentage. In single-bundle technique only the AM bundle is replaced, which doesn't fully simulate the normal ACL function during the knee range of motion. Lately we came across two-bundle ACL reconstruction techniques, witch closely reproduce normal ACL anatomy and function. In our study we present this two-bundle technique, using hamstrings autograft, the intraoperative difficulties and our early results. MATERIAL-METHOD: Between 8/04 and 1105, 20 patients were treated, suffering ACL laxity. We carried out two-bundle reconstruction of the anterior cruciate ligament (ACL) using semitendinosus tendon as PL bundle and gracilis tendon as AM bundle. The two-bundle procedure was performed using two Endobuttons for femoral graft fixation. All patients were men aged 22.5 years old (18 to 27 y.o.). The different components of the anterior cruciate ligament and their respective functions have been the object of several studies. The anteromedial bundle maintains joint stability during extension and anteroposterior stability during flexion. The posterolateral bundle contributes to the action of the anteromedial bundle with an additional effect due to its position: rotational stability during flexion. The preliminary results suggested that the two-bundle procedure showed a better trend with respect to anterior stability compared with those of our previous experience using the single-bundle technique under the same aggressive rehabilitation protocol.