Associated Anterior Cruciate Ligament and Fibular Collateral Ligament Reconstruction With Single Femoral Tunnel and Asymmetric Hamstring Tendon Graft

Abstract

A technique for associated anterior cruciate ligament and fibular collateral ligament reconstruction is shown, using a single hamstring tendon graft, which is prepared asymmetrically, leaving one-third of the length with a single diameter and two-thirds with a double diameter. A single femoral tunnel is created, using an interference screw for fixation and isolation of the grafts. A suspension device is used for tibial fixation, allowing for length adjustment according to the graft's length. The objective of this Technical Note is to provide the orthopaedic surgeon with a resource for anterior cruciate ligament and fibular collateral ligament reconstruction even with short grafts, saving bone stock and avoiding the need for allografts.

Anterior Cruciate Ligament Revision Surgery Associated to Lateral Collateral and Anterolateral Ligaments Reconstruction With Single Achilles Tendon Allograft and Single Femoral Tunnel

“…On the other hand, when a revision surgery of a failed ACL is performed, especially if an explosive pivot shift is present, an anterolateral reinforcement is indicated, both as a LET 7 or as an ALL reconstruction. 8 Different graft options have been described to reconstruct the LCL, like the semitendinosus tendon as a single graft 16 or in association to the ACL graft, 17 or a patellar tendon allograft. 18 Tunnel convergence is a matter of care in multiligament reconstructions of the knee, particularly on the lateral condyle.…”

“…Different graft options have been described to reconstruct the LCL, like the semitendinosus tendon as a single graft 16 or in association to the ACL graft, 17 or a patellar tendon allograft. 18 …”

“… 21 Other previous techniques have employed the idea of a single femoral tunnel for associated ligament reconstruction, like in the case of associated ACL and LCL reconstruction. 17 In the last years, tunnel convergence has also been studied for the associated reconstruction of the ACL with anterolateral reinforcements, for LET, 22 , 23 as well as for ALL reconstruction. 24 Single femoral tunnel techniques have also been described to avoid such convergence in the case of an associated reconstruction of ACL and ALL.…”

Arthroscopic Reconstruction of ACL and LCL Tear with Combined Asymmetric Hamstring Graft Using Single Femoral Tunnel – A Case Report

“…In this technique, we have used three strands for ACL and one strand for LCL. Native LCL has got tensile strength of about 295N, so according to Espejo-Baena et al, the reconstructed LCL has thrice the strength of the native LCL and has no chances of graft failure and thus making it a stable construct [ 11 , 12 ]. Anatomic reconstruction of ACL is combined with non-anatomic reconstruction of LCL since LCL insertion is slightly anterior to the fibula head but posterior to Gerdy’s tubercle.…”