DOUBLE BUNDLE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING RIGID-FIX PINS

Abstract

Introduction: The technique of double bundle anterior cruciate ligament (ACL) reconstruction has been proposed to be more anatomical but technically more demanding. We are presenting a simple technique using autogenous hamstring graft and Rigid-Fix pins (Mitek, Johnson & Johnson).

Materials and Methods: 2 tibial and 2 femoral tunnels are prepared using 6mm reamer for the posterolateral (PL) and 7 mm reamer for the anteromedial (AM) bundles. Trans-tibial approach was used for preparing the femoral tunnels. Double or triple gracellis graft is used for the PL and double semitendinoses for the AM bundles. On the femoral side single Rigid-Fix pin was used to fix each graft separately. 7 mm and 8 mm biodegradable screws were used for graft fixation on the tibial side for the PL and AM tunnels in sequence. The AM bundle was stabilised with the knee in 60° flexion and the leg internally rotated while the PL bundle was fixed whiles the knee in 15° flexion and external rotation. 43 patients were randomized between two groups (A), 21 patients for whom single bundle ACL reconstruction using hamstring autogenous graft, Rigid-Fix pins and interference screws and group (B) 22 patients who had double bundle ACL reconstruction using the above mentioned technique. IKDC scoring system was used for evaluation.

Results: At 18 months post-operative there was no significant difference between the two groups in the IKDC score but the return to sport and heavy manual work was higher in group B 95% compared to only 60 % in group A.

Discussion: and Conclusion: A simple and reproducible technique is described for double bundle ACL reconstruction and shown to provide better outcome for the patients who perform highly demanding physical activity.