“Ribbonlike” Double-Bundle ACL Reconstruction with Restoration of “C”-Shaped Tibial Insertion Site

Abstract

The “ribbonlike” flat shape of the ACL with the “C”-shaped tibial and “straight” femoral insertion will change our way of ACL reconstruction (see Chaps. 1, 2, 3, 4, and 5).

According to recent measurements, the dimensions at midsubstance are an average of 12.2 mm wide but only 3.6 mm flat. On the tibial side, the “C”-shaped bony insertion has an average length of 13.7 mm and a width of only 3.3 mm, and the femoral straight bony insertion along the intercondylar ridge has an average length of 16.0 mm and a width of 3.5 mm (see Chaps. 1, 2, 3, 4, and 5).

From these measurements, an anatomical flat and long footprint reconstruction may make sense. However, most “traditional” single-bundle (SB) ACL grafts are too wide and result in a too short and too wide footprint reconstruction.

For closer restoration of the flat “ribbonlike” shape, DB reconstruction may be advantageous over SB reconstruction when using hamstrings. When using a patella tendon graft or quadriceps tendon graft, the DB technique might not be necessary, as the geometry of the graft is flat (PT) or can be harvested flat (QT). However, therefore, these grafts might be associated with a higher risk of morbidity at the harvest site.

The aim of this chapter was to highlight a way of DB ACL reconstruction by restoring the “C”-shaped tibial and “straight” femoral ACL insertions using hamstrings.