Objective: To evaluate the short-term effectiveness of arthroscopic single-bundle reconstruction of anterior cruciate ligament (ACL) being centered within the native ligament's tibial and femoral insertions with independent drilling of tibial and femoral tunnels.
Methods: Between September 2008 and September 2010, 33 patients with chronic ACL ruptures underwent arthroscopic reconstruction with four-stranded hamstring tendons in single-bundle. There were 19 males and 14 females, aged 22-33 years (mean, 26.4 years). Injuries were caused by traffic accident in 15 cases, by falling in 13 cases, and by sports in 5 cases. The location was the left knee in 20 cases and the right knee in 13 cases. The average time from injury to surgery was 6 months (range, 2-20 months). ACL reconstruction could be optimized when single-bundle grafts were centered within the native ligament's tibial and femoral insertions with independent drilling of tibial and femoral tunnels. KT-1000 test, Lachman test, and pivot-shift test were used to evaluate the knee stability, and the International Knee Documentation Committee (IKDC) and Lysholm scores to assess the knee function.
Results: Primary healing of incision was obtained in all patients, who had no complications of intra-articular infection, deep venous thrombosis of the lower extremity, and injury of blood vessels and nerves. All the patients were followed up 18.6 months on average (range, 13-24 months). At 1 year after operation, the results of Lachman test were negative in 31 cases and I degree positive in 2 cases, showing significant difference when compared with preoperative results (I degree positive in 4, II degree positive in 26, and III degree positive in 3) (Z = -5.42, P = 0.00). The results of pivot-shift test were negative in 31 cases, I degree positive in 2 cases, showing significant difference when compared with preoperative results (I degree positive in 15 and II degree positive in 18) (Z = -5.17, P = 0.00). The KT-1000 results of examination (134 N) showed that the side difference of anterior laxity was (1.2 +/- 0.7) mm at 25 degrees flexion and (0.8 +/- 0.6) mm at 70 degrees flexion, showing significant differences when compared with preoperative ones [(7.8 +/- 2.1) mm and (5.0 +/- 1.8) mm] (t = 16.19, P = 0.00; t = 13.28, P = 0.00). The IKDC score was significantly increased from 39.6 +/- 4.5 at preoperation to 95.1 +/- 1.6 at postoperation (t = - 78.88, P = 0.00), and Lysholm score was significantly increased from 48.3 +/- 3.6 at preoperation to 92.0 +/- 2.5 at postoperation (t = -42.00, P = 0.00).
Conclusion: It is a reliable procedure to restore the stability of the knee that arthroscopic single-bundle reconstruction of ACL is centered within the native ligament's tibial and femoral insertions with independent drilling of tibial and femoral tunnels.