A Simplified Double-Bundle Anterior Cruciate Ligament Reconstruction by the Three-Inside Technique With Two Suspension Buttons and One Interference Screw

Abstract

In comparison with the single-bundle technique, double-bundle anterior cruciate ligament (ACL) reconstruction has proven its superiority regarding biomechanical studies and clinical outcomes in both rotational knee stability and anterior translation function. However, the complexity and risk of complications remain a great concern for the orthopaedic surgeon performing double-bundle ACL reconstruction. We present a simplified double-bundle ACL reconstruction by the 3-inside technique with 2 suspension buttons and 1 interference screw. The semitendinosus tendon is tripled to be the anteromedial (AM) bundle, whereas the gracilis is doubled for the posterolateral (PL) bundle. We perform a 3-socket approach with an inside-out femoral tunnel for the AM bundle, an outside-in femoral tunnel for the PL bundle, and a retrograde tibial socket for the tibial bundle. Thus, this technique is, simply, a combination of 2 procedures: one single all-inside method (for the AM bundle) and one outside-in method (for the PL bundle), with which most arthroscopic surgeons are familiar. The AM and PL bundles are fixed at 30 and 45 , respectively, using 2 suspension buttons and 1 interference screw. Our simplified technique could reduce surgical costs and minimize complications while maintaining isometric position and appropriate graft size for each patient.

Anterior Cruciate Ligament Reconstruction With Double-Bundle Internal Bracing: A Technique Guide

“… 17 Recent published surgical techniques for the db procedure including ours performed a triple- or quadruple-fold for the AM bundle to achieve a minimum diameter of 8 mm. 18 , 19 Furthermore, the mean age for their study was 22 years of age and numerous studies have shown adolescents and teenagers to be the age groups with greatest incidence and risk of ACL tear and graft failure after reconstruction. 20 , 21 , 22 , 23 , 24 , 25 This increase risk could be due to hormonal changes as the ACL is now known to host sex hormone receptors.…”