Double-bundle anterior cruciate ligament reconstruction with split Achilles allograft and single tibia tunnel for small ACL tibial footprint: Technical note with clinical results

In Jung Chae, Ji Hoon Bae, Joon Ho Wang, Jinho Jeon, Jong Hoon Park

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose: We describe a surgical technique of double-bundle ACL reconstruction with a single tibia tunnel and report the clinical outcome. Methods: The Achilles tendon portion was split longitudinally into two separate bundles, namely, an anteromedial (AM) bundle with 7-8 mm diameter and a posterolateral (PL) bundle with 4-6 mm diameter. The central portion of the calcaneal bone plug was prepared with a diameter of 10 mm and a length of 30 mm. For the femoral tunnel preparation, we preferred inside out target through an accessory anteromedial portal for an approach to native ACL footprint and outside in reaming through separate incision on the lateral aspect of distal thigh to prevent cartilage injury of medial femoral condyle. 10 mm diameter of single tibia tunnel was prepared at the central portion of ACL tibial footprint. After graft passage from tibia to femoral side, fixation of calcaneal bone plug within the tibia tunnel was performed using two bioabsorbable cross pins. Then, AM bundle was first fixed at 45 of flexion while the PL bundle was fixed at 10 of flexion using bioabsorbable interference screws and augmented staples. Clinical results of 22 patients (18 males and 4 females, average age 30.7 years) who underwent double-bundle anterior cruciate ligament (ACL) reconstruction with this technique were evaluated. Results: At an average follow-up of 30 months, there was significant improvement of the Lysholm knee score, the 2,000 IKDC subjective knee score, the median Tegner activity score and the side-to-side difference. According to the 2,000 IKDC knee examination form, the grade rated as normal in seven patients, nearly normal in 14 patients and abnormal in one patient at the latest follow-up. There were no postoperative complications and revisional surgeries. Conclusions: Split Achilles allograft and single tibia tunnel technique for double-bundle ACL reconstruction can be an alternative option for patients with small tibial insertion sites. Level of evidence: Level IV, therapeutic study.

Original languageEnglish
Pages (from-to)819-825
Number of pages7
JournalArchives of Orthopaedic and Trauma Surgery
Volume133
Issue number6
DOIs
Publication statusPublished - 2013 Jun 1

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Anterior Cruciate Ligament Reconstruction
Anterior Cruciate Ligament
Tibia
Allografts
Thigh
Bone and Bones
Knee
Achilles Tendon
Cartilage
Transplants
Wounds and Injuries

Keywords

  • Achilles tendon
  • Anterior cruciate ligament
  • Arthroscopy
  • Double-bundle
  • Tibia

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

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title = "Double-bundle anterior cruciate ligament reconstruction with split Achilles allograft and single tibia tunnel for small ACL tibial footprint: Technical note with clinical results",
abstract = "Purpose: We describe a surgical technique of double-bundle ACL reconstruction with a single tibia tunnel and report the clinical outcome. Methods: The Achilles tendon portion was split longitudinally into two separate bundles, namely, an anteromedial (AM) bundle with 7-8 mm diameter and a posterolateral (PL) bundle with 4-6 mm diameter. The central portion of the calcaneal bone plug was prepared with a diameter of 10 mm and a length of 30 mm. For the femoral tunnel preparation, we preferred inside out target through an accessory anteromedial portal for an approach to native ACL footprint and outside in reaming through separate incision on the lateral aspect of distal thigh to prevent cartilage injury of medial femoral condyle. 10 mm diameter of single tibia tunnel was prepared at the central portion of ACL tibial footprint. After graft passage from tibia to femoral side, fixation of calcaneal bone plug within the tibia tunnel was performed using two bioabsorbable cross pins. Then, AM bundle was first fixed at 45 of flexion while the PL bundle was fixed at 10 of flexion using bioabsorbable interference screws and augmented staples. Clinical results of 22 patients (18 males and 4 females, average age 30.7 years) who underwent double-bundle anterior cruciate ligament (ACL) reconstruction with this technique were evaluated. Results: At an average follow-up of 30 months, there was significant improvement of the Lysholm knee score, the 2,000 IKDC subjective knee score, the median Tegner activity score and the side-to-side difference. According to the 2,000 IKDC knee examination form, the grade rated as normal in seven patients, nearly normal in 14 patients and abnormal in one patient at the latest follow-up. There were no postoperative complications and revisional surgeries. Conclusions: Split Achilles allograft and single tibia tunnel technique for double-bundle ACL reconstruction can be an alternative option for patients with small tibial insertion sites. Level of evidence: Level IV, therapeutic study.",
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T1 - Double-bundle anterior cruciate ligament reconstruction with split Achilles allograft and single tibia tunnel for small ACL tibial footprint

T2 - Technical note with clinical results

AU - Chae, In Jung

AU - Bae, Ji Hoon

AU - Wang, Joon Ho

AU - Jeon, Jinho

AU - Park, Jong Hoon

PY - 2013/6/1

Y1 - 2013/6/1

N2 - Purpose: We describe a surgical technique of double-bundle ACL reconstruction with a single tibia tunnel and report the clinical outcome. Methods: The Achilles tendon portion was split longitudinally into two separate bundles, namely, an anteromedial (AM) bundle with 7-8 mm diameter and a posterolateral (PL) bundle with 4-6 mm diameter. The central portion of the calcaneal bone plug was prepared with a diameter of 10 mm and a length of 30 mm. For the femoral tunnel preparation, we preferred inside out target through an accessory anteromedial portal for an approach to native ACL footprint and outside in reaming through separate incision on the lateral aspect of distal thigh to prevent cartilage injury of medial femoral condyle. 10 mm diameter of single tibia tunnel was prepared at the central portion of ACL tibial footprint. After graft passage from tibia to femoral side, fixation of calcaneal bone plug within the tibia tunnel was performed using two bioabsorbable cross pins. Then, AM bundle was first fixed at 45 of flexion while the PL bundle was fixed at 10 of flexion using bioabsorbable interference screws and augmented staples. Clinical results of 22 patients (18 males and 4 females, average age 30.7 years) who underwent double-bundle anterior cruciate ligament (ACL) reconstruction with this technique were evaluated. Results: At an average follow-up of 30 months, there was significant improvement of the Lysholm knee score, the 2,000 IKDC subjective knee score, the median Tegner activity score and the side-to-side difference. According to the 2,000 IKDC knee examination form, the grade rated as normal in seven patients, nearly normal in 14 patients and abnormal in one patient at the latest follow-up. There were no postoperative complications and revisional surgeries. Conclusions: Split Achilles allograft and single tibia tunnel technique for double-bundle ACL reconstruction can be an alternative option for patients with small tibial insertion sites. Level of evidence: Level IV, therapeutic study.

AB - Purpose: We describe a surgical technique of double-bundle ACL reconstruction with a single tibia tunnel and report the clinical outcome. Methods: The Achilles tendon portion was split longitudinally into two separate bundles, namely, an anteromedial (AM) bundle with 7-8 mm diameter and a posterolateral (PL) bundle with 4-6 mm diameter. The central portion of the calcaneal bone plug was prepared with a diameter of 10 mm and a length of 30 mm. For the femoral tunnel preparation, we preferred inside out target through an accessory anteromedial portal for an approach to native ACL footprint and outside in reaming through separate incision on the lateral aspect of distal thigh to prevent cartilage injury of medial femoral condyle. 10 mm diameter of single tibia tunnel was prepared at the central portion of ACL tibial footprint. After graft passage from tibia to femoral side, fixation of calcaneal bone plug within the tibia tunnel was performed using two bioabsorbable cross pins. Then, AM bundle was first fixed at 45 of flexion while the PL bundle was fixed at 10 of flexion using bioabsorbable interference screws and augmented staples. Clinical results of 22 patients (18 males and 4 females, average age 30.7 years) who underwent double-bundle anterior cruciate ligament (ACL) reconstruction with this technique were evaluated. Results: At an average follow-up of 30 months, there was significant improvement of the Lysholm knee score, the 2,000 IKDC subjective knee score, the median Tegner activity score and the side-to-side difference. According to the 2,000 IKDC knee examination form, the grade rated as normal in seven patients, nearly normal in 14 patients and abnormal in one patient at the latest follow-up. There were no postoperative complications and revisional surgeries. Conclusions: Split Achilles allograft and single tibia tunnel technique for double-bundle ACL reconstruction can be an alternative option for patients with small tibial insertion sites. Level of evidence: Level IV, therapeutic study.

KW - Achilles tendon

KW - Anterior cruciate ligament

KW - Arthroscopy

KW - Double-bundle

KW - Tibia

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