Arthroscopic anterior cruciate ligament reconstruction with quadruple semitendinosus and gracilis tendon autograft: Surgical technique and clinical results

Indications for surgical reconstruction of the anterior cruciate ligament (ACL) include a grade III or IV injury, combined ligament injuries, and symptomatic anterior instability. Although the patellar tendon has traditionally been the gold standard graft choice for reconstruction, the hamstring tendon has now also become a popular graft choice because its use reduces postoperative anterior knee pain and donor site morbidity. From March 1996 to December 1996, we used hamstring tendon grafts for the surgical reconstruction of the ACL in 26 patients. All patients were followed and evaluated for an average of 28 months. Return to the same or higher level of pre-injury sports activity was achieved in 22 of the 26 patients (85%). Overall outcome as measured by the International Knee Documentation Committee (IKDC) rating was normal or nearly normal in 23 of the 26 patients (88%). The overall 100-point Subjective Knee Score was 87.4. Cybex dynamometer testing showed that quadriceps strength of the operated knee recovered to more than 80% of the normal knee in 24 of 26 patients (92%). One patient had hamstring muscle power limitation. For the assessment of tunnel expansion after ACL reconstruction, the diameter of the bone tunnel was measured and compared with the original reamed diameter. Enlargement of at least 2 mm was found in 5 femoral tunnels (19%) and in 3 tibial tunnels (12%). In this report, we describe the surgical technique of arthroscopic ACL reconstruction with autograft of quadruple hamstring tendons, including double loops of semitendinosus and gracilis tendons. A new fixation method was used in which Mersilene tape and a washer were applied at the femoral side and sutures of tendons to a screw at the tibial side. This technique is easy to learn and does not require any specific fixation device. The clinical results at a minimum 2-year follow-up with this technique were satisfactory in 88% of patients.