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01.04.2015 | Knee | Ausgabe 4/2015

Knee Surgery, Sports Traumatology, Arthroscopy 4/2015

Outcome of anatomical double-bundle ACL reconstruction using hamstring tendons via an outside-in approach

Knee Surgery, Sports Traumatology, Arthroscopy > Ausgabe 4/2015
Hiroshi Amano, Yukiyoshi Toritsuka, Ryohei Uchida, Tatsuo Mae, Kenji Ohzono, Konsei Shino



To evaluate the clinical outcome of anatomical double-bundle anterior cruciate ligament (ACL) reconstruction using multistranded hamstring tendons via an outside-in approach.


One hundred and twenty-one patients (mean age 28 ± 10 years) who underwent ACL reconstruction were examined. Using an outside-in femoral drill guide, an upper femoral tunnel for the anteromedial (AM) graft was created just below the superior articular cartilage margin of the medial wall of the lateral condyle through a small incision. A lower femoral tunnel for the posterolateral (PL) graft was drilled in the centre of the inferior–posterior half of the attachment area behind the resident’s ridge in the same manner. Two tibial tunnels were created at the centre of the AM and PL bundle footprints of a normal ACL. Patients were evaluated at 24 months postoperatively.


According to the IKDC form, 52 knees (43 %) were graded as normal, 64 (53 %) as nearly normal, 1 (1 %) as abnormal and 4 (3 %) as graft rupture due to re-injury. Loss of knee extension of <5° was observed in one patient (1 %). Among 111 patients who were directly evaluated, none showed loss of flexion of <5°. Lachman sign was negative in 103 patients (93 %), while the pivot shift test result was negative or equivalent to that of the contralateral healthy knee in 103 patients (93 %). The mean side-to-side difference in anterior laxity at manual maximum force with the KT-2000 arthrometer® was 0.9 ± 1.1 mm, and 94 % of patients showed a range between −1 and +2 mm.


The anatomical double-bundle outside-in ACL reconstruction provided a satisfactory short-term outcome.

Level of evidence

Case series, Level IV.

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