The aim of our study was to examine the outcome of ACL reconstruction by using four strand hamstring tendon autografts.

Material and Methods: the study included 44 patients (29 males,15 females;mean age 26;18–45 years). The diagnosis was based on clinical examination and imaging techniques. The operation was performed arthroscopically 4–62 weeks after the injury. The tendon was fixed in the tibia with an interference screw and in the femur with three different methods cross pin in 16 cases, transfix pin in 11 cases and Endo button in 17 cases.

Results: The mean follow up was 28 months (12–42). The mean Lysholm score was improved from 35–65 (mean 49) preoperativelly to 55–100 postoperativelly (mean 88).

5 patients had laxity > 3mm when compared to the healthy knee by using the KT-1000 arhthrometric testing. 2 of the latter patients complained of a feeling of knee joint instability which occurred due to inaccurate positioning of the femoral tunnel. In 2 cases the transfix pins were displaced and removed on the 4th and 15th post-operative month.

The tunnel expansion was measured by an X-Ray or a CT scan. The tibial tunnel expansion was 0–2.5mm (mean 1.2) or 18% and the femoral tunnel expansion was 0–3 mm (mean 1.4) or 26%. 8 patients reported mild pain which did not restrict their activities. A 5 degree loss of extension was noticed in one patient who continues physiotherapy.

28 of the above patients suffered also from a meniscal injury that was managed arthroscopically.

Conclusion: ACL reconstruction by using four strand hamstring tendon autografts is safe, highly successful with very few complications when proper graft preparation and accurate tunnel placement is achieved.