A new bicortical tibial fixation technique in anterior cruciate ligament reconstruction with quadruple hamstring graft

We report a prospective series of 101 patients receiving a four-strand semi tendinosus-gracilis autograft for anterior cruciate ligament reconstruction using a new bicortical tibial fixation technique with bioabsorbable interf erence screws. Patients (average age 32 years) were operated on between Nov ember 1997 and Mai 1998, and follow-up was at least 12 months postoperative ly. The evaluation consisted of history, clinical examination, IKDC score, Cincinnati Knee Score, KT-1000 testing, standardized radiography and magnet ic resonance imaging. One hundred patients were available for follow-up. Th ere were two traumatic reruptures 6 and 11 months postoperatively. By IKDC score 87 patients were in groups A and B, 12 in group C, and 2 with a rerup ture in group D. Mean Cincinnati Knee Score was 82 (range 46-100), KT-1000 manual maximum at follow-up showed an average difference of 1.7 mm between the sides. Full extension was rapidly achieved in all cases, and flexion av eraged 135 degrees. Considering the enlargement caused by the bioabsorbable interference screws, the incidence of tunnel widening was 6.6% on the femo ral side and 1.7% on the tibial side. Tunnel widening did not affect the cl inical results. Three patients experienced an effusion after more than 6 mo nths postoperatively. There was one infection, which settled without functi onal impairment after early arthroscopic lavage and intravenous antibiotics . Otherwise no complications occurred. The described technique for anterior cruciate ligament reconstruction combines the advantage of anatomical graf t position with sufficient graft fixation. A short intra-articular graft co nstruct with a strong tendon to bone interface was created. Clinically, 87% of patients had a normal or nearly normal IKDC score at follow-up. Magneti c resonance imaging revealed a considerable increase in tunnel area caused by the insertion of the interference screws. On the ether hand, the develop ment of a "fibrous interzone" between the graft and the bone tunnel was pre vented in most cases. At short-term follow-up the bicortical tibial fixatio n proved to be efficient even with an aggressive rehabilitation program.