Summary

Simultaneous bilateral ACL reconstruction using a combination of autograft and allograft tissues provides an effective and efficient approach for treating bilateral ACL injuries, optimizing recovery and rehabilitation.

Abstract

Introduction

Bilateral anterior cruciate ligament (ACL) injury is a rare medical condition, accounting for approximately 0.5% to 2% of ACL injuries annually in the USA. Traditionally, staged reconstruction of bilateral ACL injuries is favored, allowing the patient to rehabilitate one knee before undergoing surgery on the contralateral side. However, this approach lengthens the total recovery period and delays the return to full activity. A simultaneous bilateral reconstruction can offer advantages such as reduced time away from work or sport and a unified rehabilitation process, but it requires careful consideration of graft choices and surgical technique to optimize outcomes and minimize complications.

Methods

We present a 31-year-old male patient who in the time waiting for surgery for ACL rupture in the left knee suffered a fall and had a contralateral ACL rupture. After thorough preoperative assessment, the decision was made to proceed with simultaneous bilateral ACL reconstruction using a combination of autograft and allograft tissues. The procedure involved harvesting the semitendinosus tendon from the patient’s left knee and the rectus femoris tendon from the patient’s right knee. Additionally, semitendinosus and rectus femoris tendons were sourced from a tissue bank to be used as allografts. In the right knee, the reconstruction was performed using an allograft semitendinosus tendon in combination with an autologous rectus femoris tendon. In the left knee, the opposite configuration was used: an autologous semitendinosus tendon and an allograft rectus femoris tendon. Both graft had a diameter >8mm and sufficient lenght for proper placement. Arthroscopic-assisted techniques were employed, with careful intraoperative monitoring to ensure optimal graft placement and fixation: cortical suspension for the femoral bone and interference screw for the tibial bone. The total operative time was approximately 130 minutes.

Results

The patient’s postoperative course was uneventful, with no immediate complications. Early mobilization was initiated on the first postoperative day, with weight-bearing as tolerated. A comprehensive rehabilitation program focusing on quadriceps strengthening, range of motion exercises, and proprioceptive training has been stablished. At the last follow up (2 months postoperatively) the patient presents with full range of motion, no pain and no significant differences in stability or strength between the two knees.

Discussion

This case illustrates the potential benefits of simultaneous bilateral ACL reconstruction using a combination of autograft and allograft tissues. The use of mixed graft sources allowed for the preservation of autologous tissue while providing sufficient graft material for effective reconstruction of both knees. The choice of graft configuration was guided by the need to balance graft strength, tissue compatibility, and surgical feasibility. The outcomes suggest that this approach can lead to excellent functional results, with the added advantage of a more streamlined rehabilitation process.

Conclusion

Simultaneous bilateral ACL reconstruction using a combination of autograft and allograft tissues is a viable option for selected patients with bilateral ACL injuries. This technique offers the benefits of reduced recovery time and synchronized rehabilitation while maintaining high standards of surgical efficacy.