One-stage anatomic double-bundle anterior and posterior cruciate ligament reconstruction using the autogenous hamstring tendons

This is the first report of an anatomic double-bundle ACL and PCL reconstruction procedure with the autogenous hamstring tendons. We prepare two pairs of the doubled tendon grafts, to which a polyester tape and an Endobutton-CL are attached using our original technique at the tibial and femoral ends, respectively. Under arthroscopic and fluoroscopic observations, two tibial tunnels for PCL reconstruction are created so that they pass through the posteromedial and anterolateral bundle attachments, respectively. Then, we create two tibial tunnels for anatomic double-bundle ACL reconstruction so that each tunnel axis is aimed at a targeted point on the femoral condyle. Using the outside-in technique, two femoral tunnels for PCL reconstruction are created so that the tunnel outlets are located at the center of the anterolateral and posteromedial bundle attachments. Then, two femoral tunnels for anatomic double-bundle ACL reconstruction are created with the trans-tibial tunnel technique. After the two grafts have been placed for PCL reconstruction, the two grafts are placed for ACL reconstruction. After all the femoral graft ends are fixed, the knee joint is reduced to the full extension position, and then, the four tibial tape portions are simultaneously fixed with the turn-buckle stapling technique.