Summary

This Rectangular Tunnel Footprint Enhancing Single Bundle ACL Reconstruction technique using Graft Squeezing Hamstring Tendon Provides Excellent Rotational and Antero-Posterior Knee Stability.

Abstract

Objective

The study aims to investigate the feasibility, efficacy, and potential benefits of utilizing foot print optimization single tunnel double-bundle approach in Anterior Cruciate Ligament reconstruction surgery.

Methods

Thirty-five patients undergoing Anterior Cruciate Ligament Reconstruction were prospectively enrolled. Anterior cruciate ligament tunnel made using patented rectangular tunnel dilators. This rectangular tunnel optimizes foot print of Anterior cruciate ligament, thereby mimicking double bundle like effect with single tunnel. Soft tissue hamstring grafts used in all patients. Graft squeezing method used for graft passage and fixed with suspensory on femoral side and aperture fixation on tibial side. Patient outcomes were evaluated at a mean follow-up of 3 years using passive knee range of motion (ROM), Lysholm score, international knee documentation committee (IKDC) score, Lachman test for anteroposterior stability, and pivot-shift test for rotational stability.

Results

The study observed encouraging results in terms of rehabilitation progress and return to activities of daily living (ADL). Passive Knee range of motion (ROM) exhibited a significant enhancement in knee flexion following surgery, as the average pre-operative ROM of 106 degrees increased to 134 degrees at the 36-month follow-up. ROM remained stable throughout the following years. The Lysholm knee score and IKDC scores, steadily improved from a pre-operative of 52.46±8.13 to 92.79±1.00 and 34.43±4.13 preoperatively to 86.43±0.61 respectively at final follow up of 36 months. Therefore, all evaluated parameters demonstrated positive outcomes. However, one complication, a Cyclops lesion, was identified.

Conclusion

This single-tunnel double-bundle Anterior Cruciate Ligament Reconstruction technique with a unique tunnel dilatation system and graft squeezing technique shows promising potential for achieving good functional outcomes and restoring knee stability. Long-term follow-up studies with a larger patient population are warranted to further validate these findings.

Keywords - Anteromedial, anterior cruciate ligament, tunnel dilator, posterolateral, reconstruction.