Bi-socket ACL reconstruction using hamstring tendons: high versus low femoral socket placement

To clarify the importance of the femoral socket location in bi-socket Anterior cruciate ligament (ACL) reconstruction. Subjects included 261 patients with an average age of 26 years who received ACL reconstruction via the high-femoral socket procedure (Group H) and 43 patients with an average age of 29 years who received ACL reconstruction via the low-femoral socket procedure (Group L) with a minimal follow-up of 24 months. In Group H, the femoral sockets were created at 1:00 or 11:00 and 2:00–2:30 or 9:30–10:00 of the intercondylar notch. In Group L, the two femoral sockets were drilled at 2:00 or 10:00 and 3:00 or 9:00. For the tibial side, a single tunnel was made at the center of the footprint. Evaluation was performed based on the IKDC Knee Examination Form. While 137 knees (52%) were graded as normal, 100 (38%) as nearly normal, 8 (3%) as abnormal, and 2 (1%) as severely abnormal with 14 (5%) re-injury in Group H, 38 knees (74%) were graded as normal, and 7 (16%) as nearly normal with 3 (7%) re-injury in Group L, showing a better subjective evaluation (P = 0.007). The average side-to-side differences in anterior laxity at manual maximum force with the KT-1000 were 1.1 ± 1.6 mm for Group H and 1.0 ± 1.6 mm for Group L without statistically significant differences excluding re-injured cases. There were 204 patients (83%) from Group H and 33 (83%) from Group L with values between −2 and 2 mm, while 228 (92%) patients from Group H and 38 (95%) from Group L had values distributed between −3 and 3 mm. While the bi-socket ACL reconstruction provided objectively satisfactory clinical outcomes in more than 90% of the patients, the low-femoral socket placement was found to subjectively achieve better outcomes.