Anatomic Double-Bundle ACL Reconstruction With Extra-articular Anterolateral Ligament Reconstruction and Internal Brace

Chih-Hao Chiu; Jia-En Chi; Po-Hua Huang; Shih-Sheng Chang; Kuo-Yao Hsu; Alvin Chao-Yu Chen; Yi-Sheng Chan

doi:10.1016/j.eats.2020.10.069

Anatomic Double-Bundle ACL Reconstruction With Extra-articular Anterolateral Ligament Reconstruction and Internal Brace

Arthrosc Tech. 2021 Mar 10;10(3):e789-e796. doi: 10.1016/j.eats.2020.10.069. eCollection 2021 Mar.

Authors

Chih-Hao Chiu^{1

2}, Jia-En Chi^{2

3}, Po-Hua Huang⁴, Shih-Sheng Chang^{1

2}, Kuo-Yao Hsu^{2

3}, Alvin Chao-Yu Chen^{2

3}, Yi-Sheng Chan^{2

3}

Affiliations

¹ Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
² Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
³ Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
⁴ Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.

Abstract

Anterior cruciate ligament reconstruction (ACLR) with additional procedures could be necessary for patients with increased preoperative pivot shift. Double-bundle (DB) ACLR provides more footprint coverage and recreates the 2 functional anteromedial (AM) and posterolateral (PL) bundles, which are believed to give better joint function and stability than single-bundle (SB) ACLR. Internal brace augmentation with suture tape is proposed along with tendon graft in ACLR to protect the newly reconstructed ligament during rehabilitation. Additional reconstruction with anterolateral ligament (ALL) during ACLR has shown significant reduction in the level of persistent pivot shift. In Technical Note we present a modified surgical technique of combined anatomic DB ACLR and ALLR with hamstring autograft and internal brace, using button suspensory fixation device and aperture screws. The objective of this technique is to decrease residual anterior and rotational instability after ACLR and ALLR.