Two-bundle reconstruction of the anterior cruciate ligament using semitendinosus tendon with endobuttons: Operative technique and preliminary results

We carried out two-bundle reconstruction of the anterior cruciate ligament (ACL) using multi-strand semitendinosus tendon for the purpose of getting better stability under aggressive rehabilitation by putting the graft in the normal anatomy with minimized notch-plasty. The drill guide position was determined using two-directional radiography in hyperextension. The two-bundle procedure was performed using the inside-out technique for grafting and two Endobuttons (Acufex Microsurgical, Mansfield, MA) for femoral graft fixation. The clinical outcomes 2 years postoperatively of 54 of 62 consecutive patients were reported. The preliminary results suggested that the two-bundle procedure showed a better trend with respect to anterior stability compared with those of our previous experience using the single-bundle technique under the same aggressive rehabilitation. The two-bundle procedures have several theoretical advantages over single-bundle with multi-strand tendon graft. The present two-bundle reconstruction is recommended to result in better anterior stability with minimized notch-plasty and with no serious complications.