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J Knee Surg 2013; 26(01): 069-074
DOI: 10.1055/s-0032-1319777
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

“Figure 8” Single Socket Double Bundle ACL Technique

Joseph W. Greene
1   Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky
,
Ruben Gonzalez
1   Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky
,
Travis E. Clegg
1   Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky
,
David N.M. Caborn
1   Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky
› Author Affiliations
Further Information

Publication History

05 August 2011

13 March 2012

Publication Date:
28 June 2012 (online)

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Abstract

Using single femoral and tibial tunnels, we describe a technique of anatomically recreating the anteromedial and posterolateral anterior cruciate ligament (ACL) bundles. Transtibial, flexible reamers are utilized to create a “Figure 8” notched tunnel thereby recreating the anatomic footprint of the femoral insertion of the ACL. Rotational control of the individual bundles is created via the notched tunnel and each bundle is tensioned to 80 N individually. Anatomic double bundle ACL reconstruction is created in a reproducible modified single-bundle technique without the inherent risks associated with drilling four tunnels.

Keywords

double bundle - anterior cruciate ligament - flexible reamers
 

  • Reference

  • 1 Glickson J: American Academy of Orthopaedic Surgeons. Academy news. The 2004 annual meeting edition of the AAOS bulletin. Available at: http://www.aaos.org/wordhtml/2004news/c10-4.htm
    PubMedGoogle Scholar
  • 2 Garrett W, Swiohtkowski M, Weinstein J , et al. American Board of Orthopedic Surgery practice of the orthopedic surgeon: part II, certificate examination case mix. J Bone Joint Surg Am 2006; 88: 660-667
    CrossrefPubMedGoogle Scholar
  • 3 Muneta T, Sekiya I, Yagishita K, Ogiuchi T, Yamamoto H, Shinomiya K. Two-bundle reconstruction of the anterior cruciate ligament using semitendinosus tendon with endobuttons: operative technique and preliminary results. Arthroscopy 1999; 15 (6) 618-624
    CrossrefPubMedGoogle Scholar
  • 4 Siebold R, Dehler C, Ellert T. Prospective randomized comparison of double-bundle versus single-bundle anterior cruciate ligament reconstruction. Arthroscopy 2008; 24 (2) 137-145
    CrossrefPubMedGoogle Scholar
  • 5 Muneta T, Koga H, Mochizuki T , et al. A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques. Arthroscopy 2007; 23 (6) 618-628
    CrossrefPubMedGoogle Scholar
  • 6 Siebold R. Observations on bone tunnel enlargement after double bundle anterior cruciate ligament reconstruction. Arthroscopy 2007; 23 (3) 291-298
    CrossrefPubMedGoogle Scholar
  • 7 Sundaram RO, Cohen D, Barton-Hanson N. Tibial plateau fracture following gracilis-semitendinosus anterior cruciate ligament reconstruction: The tibial tunnel stress riser. Knee 2006; 13 (3) 238-240
    CrossrefPubMedGoogle Scholar
  • 8 Rosson JW, Petley GW, Shearer JR. Bone structure after removal of internal fixation plates. J Bone Joint Surg Br 1991; 73 (1) 65-67
    PubMedGoogle Scholar
  • 9 Rosson J, Egan J, Shearer J, Monro P. Bone weakness after the removal of plates and screws. Cortical atrophy or screw holes?. J Bone Joint Surg Br 1991; 73 (2) 283-286
    PubMedGoogle Scholar
  • 10 Rosson JW, Shearer JR. Refracture after the removal of plates from the forearm. An avoidable complication. J Bone Joint Surg Br 1991; 73 (3) 415-417
    CrossrefPubMedGoogle Scholar
  • 11 Morgan E, Steensen RN. Traumatic proximal tibial fracture following anterior cruciate ligament reconstruction. Am J Knee Surg 1998; 11 (3) 193-194
    PubMedGoogle Scholar
  • 12 Delcogliano A, Chiossi S, Caporaso A, Franzese S, Menghi A. Tibial plateau fracture after arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 2001; 17 (4) E16
    PubMedGoogle Scholar
  • 13 Mithöfer K, Gill TJ, Vrahas MS. Tibial plateau fracture following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2004; 12 (4) 325-328
    PubMedGoogle Scholar
  • 14 Wiley WB, Owen JR, Pearson SE, Wayne JS, Goradia VK. Medial femoral condyle strength after tunnel placement for single- and double-bundle posterior cruciate ligament reconstruction. J Knee Surg 2007; 20 (3) 223-227
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Mink JH, Deutsch AL. Occult cartilage and bone injuries of the knee: detection, classification, and assessment with MR imaging. Radiology 1989; 170 (3 Pt 1) 823-829
    PubMedGoogle Scholar
  • 16 Speer KP, Spritzer CE, Bassett III FH, Feagin Jr JA, Garrett Jr WE. Osseous injury associated with acute tears of the anterior cruciate ligament. Am J Sports Med 1992; 20 (4) 382-389
    CrossrefPubMedGoogle Scholar
  • 17 Spindler KP, Schils JP, Bergfeld JA , et al. Prospective study of osseous, articular, and meniscal lesions in recent anterior cruciate ligament tears by magnetic resonance imaging and arthroscopy. Am J Sports Med 1993; 21 (4) 551-557
    CrossrefPubMedGoogle Scholar
  • 18 Vellet AD, Marks PH, Fowler PJ, Munro TG. Occult posttraumatic osteochondral lesions of the knee: prevalence, classification, and short-term sequelae evaluated with MR imaging. Radiology 1991; 178 (1) 271-276
    CrossrefPubMedGoogle Scholar
  • 19 Faber KJ, Dill JR, Amendola A, Thain L, Spouge A, Fowler PJ. Occult osteochondral lesions after anterior cruciate ligament rupture. Six-year magnetic resonance imaging follow-up study. Am J Sports Med 1999; 27 (4) 489-494
    PubMedGoogle Scholar
  • 20 Hall MP, Ryzewicz M, Walsh PJ, Sherman OH. Risk of iatrogenic injury to the peroneal nerve during posterolateral femoral tunnel placement in double-bundle anterior cruciate ligament reconstruction. Am J Sports Med 2009; 37 (1) 109-113
    PubMedGoogle Scholar
  • 21 Zelle BA, Vidal AF, Brucker PU, Fu FH. Double bundle reconstruction of the anterior cruciate ligament: anatomic and biomechanical rationale. J Am Acad Orthop Surg 2007; 15 (2) 87-96
    CrossrefPubMedGoogle Scholar
  • 22 Silver AG, Kaar SG, Grisell MK, Reagan JM, Farrow LD. Comparison between rigid and flexible systems for drilling the femoral tunnel through an anteromedial portal in anterior cruciate ligament reconstruction. Arthroscopy 2010; 26 (6) 790-795
    PubMedGoogle Scholar
  • 23 Caborn DNM, Chang HC. Single Femoral Socket Double-Bundle ACL Reconstruction Using Tibialis Anterior Tendon: Description of a New Technique. Arthroscopy 2005; 21 (10) 1273-1283
    PubMedGoogle Scholar
  • 24 Fu FH, Jordan SS. The lateral intercondylar ridge—a key to anatomic anterior cruciate ligament reconstruction. J Bone Joint Surg Am 2007; 89 (10) 2103-2104
    CrossrefPubMedGoogle Scholar
  • 25 Steenlage E, Brand Jr JC, Johnson DL, Caborn DNM. Correlation of bone tunnel diameter with quadrupled hamstring graft fixation strength using a biodegradable interference screw. Arthroscopy 2002; 18 (8) 901-907
    PubMedGoogle Scholar
  • 26 Colombet P, Robinson J, Christel P , et al. Morphology of anterior cruciate ligament attachments for anatomic reconstruction: a cadaveric dissection and radiographic study. Arthroscopy 2006; 22 (9) 984-992
    CrossrefPubMedGoogle Scholar
  • 27 Mochizurki T, Muneta T, Nagase T , et al. Cadaveric knee observation study for describing anatomic femoral tunnel placement for two-bundle anterior cruciate ligament reconstruction. Arthroscopy 2006; 22: 356-361
    PubMedGoogle Scholar
  • 28 Easom JC, Goradia VK, Pearson SE, Wiley WB. Anterior cruciate ligament tensioning: KT-1000 measurements after ACL reconstruction and tensioning (SS-68). Arthroscopy 2004; 20: e32
    PubMedGoogle Scholar
  • 29 Arneja S, McConkey MO, Mulpuri K , et al. Graft tensioning in anterior cruciate ligament reconstruction: a systematic review of randomized controlled trials. Arthroscopy 2009; 25 (2) 200-207
    CrossrefPubMedGoogle Scholar
  • 30 Aït Si Selmi T, Fithian D, Neyret P. The evolution of osteoarthritis in 103 patients with ACL reconstruction at 17 years follow-up. Knee 2006; 13 (5) 353-358
    CrossrefPubMedGoogle Scholar
  • 31 Yasuda K, Kondo E, Ichiyama H, Tanabe Y, Tohyama H. Clinical evaluation of anatomic double bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: comparison among 3 different procedures. Arthroscopy 2006; 22 (3) 240-251
    CrossrefPubMedGoogle Scholar