Introduction and purpose: Currently there is still discussion as to the best choice of graft for ACL (anterior cruciate ligament) reconstruction. The patellar tendon offers greater stability, but the technique using the attachments of tendons forming the pes anserinus has lower morbidity. We studied cases of surgery performed in our department 7 years ago using a four-strand semitendinosus and gracilis graft, analyzing results and complications.

Materials and methods: We reviewed 130 patients that underwent surgery from 1999 to 2006. Plasty using the pes anserinus technique with a monotunnel was used on all of them, femoral stabilization was achieved with a transverse rigidfix system and tibial fixation with a resorbable intrafix system. Of the total, 39% had acute fractures and the rest chronic lesions more than 6 weeks old. Thirty menisectomies and 7 associated sutures were performed. In 21 patients diverse chondral lesions were found. Postoperatively a compressive bandage was used, hospital discharge was at 24–48 hours, early rehabilitation was used and no weight-bearing was allowed for 2 weeks, with complete weight-bearing allowed at 6 weeks.

Results: Knee functionality and clinical symptoms were analyzed by means of the IKDC scale with good outcomes in 88% of cases and a mean joint balance of 132°; 12% of the cases had residual patellofemoral clinical signs, 4 patients had Cyclops syndrome, there were 2 plasty tears, 7 cases of lax plasties, 3 cases of joint infection, 1 case of deep vein thrombosis.

Conclusions: Patients treated by four-strand grafting, according to a recent metaanalysis, have less symptoms and extension defects of the knee in comparison with patients treated with a patellar tendon graft. These are significant points to keep in mind in athletes. The improvement of stability in patellar tendon plasty is questionable in the majority of patients. Transverse fixation systems such as rigidfix avoid technical difficulties.