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Purpose In anterior cruciate ligament reconstruction with looped soft‐tissue grafts, an interference screw is frequently used for tibial fixation. This study compared three alternatives thought to improve the initial mechanical properties of direct bioabsorbable interference screw fixation: suturing the graft to close the loop, adding a supplementary staple, or increasing the oversize of the screw diameter relative to the bone tunnel from 1 to 2 mm. Methods Twenty‐eight porcine tibiae and porcine flexor digitorum profundus tendons were randomized into four testing groups: a base fixation using 10‐mm‐diameter screw with open‐looped graft, base fixation supplemented by an extracortical staple, base fixation but closing the looped graft by suturing its ends, and base fixation but using an 11‐mm screw. Graft and bone tunnel diameters were 9 mm in all specimens. Constructs were subjected to cyclic tensile load and finally pulled to failure to determine their structural properties. Results The main mode of failure in all groups was pull‐out of tendon strands after slippage past the screw. The sutured graft group displayed significantly lower residual displacement (mean value reduction: 47–67 %) and higher yield load (mean value increase: 38–54 %) than any alternative tested. No other statistical differences were found. Conclusions Suturing a soft‐tissue graft to form a closed loop enhanced the initial mechanical properties of tibial fixation with a bioabsorbable interference screw in anterior cruciate ligament reconstructions using a porcine model, and thus, this may be an efficient means to help in reducing post‐operative laxity and early clinical failure. No mechanical improvement was observed for an open‐looped tendon graft by adding an extracortical staple to supplement the screw fixation or by increasing the oversize of the screw to tunnel diameter from 1 to 2 mm.

The aim of this study is to present a surgical augmentation technique for partial ACL ruptures in which an isolated, autologous, double-bundle semitendinosus tendon graft is passed over the top of the femur, thus fully preserving the still-intact fibers of the ligament remnant. Between 1992 and 2006, 24 patients underwent ACL semitendinosus autograft reconstruction and were followed up for at least 2 years. The median follow-up was 6.2 years (2-15.6). At the last follow-up examination, the patients were evaluated using the International Knee Documentation Committee scale. Subjective and functional parameters were assessed using the Tegner activity scale and the Lysholm scale. Instrumental evaluation was carried out using the KT-1000 instrument. Sixteen of the 24 patients achieved an IKDC score of A. Of the remaining eight patients, six achieved an IKDC score of B, one an IKDC score of C, and one an IKDC score of D. According to the Tegner activity scale, the median pre-injury sports activity level was seven (5-9) and the median post-injury level was six (4-9), while the mean Lysholm scale score was 95 (90-100). Clinical and biomechanical studies have shown that reconstruction techniques that address both bundles of the ACL provide better rotational stability than techniques that address only a single bundle. Therefore, it seems logical than in patients with a partial rupture of the ACL, the intact bundle could be preserved and only the torn bundle would need to be reconstructed.

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