Reconstruction of the Anterior Cruciate Ligament of the Knee Using a Doubled Tendon Graft

The anterior cruciate ligament of the knee was reconstructed in 14 patients using doubled semitendinosus tendon graft put through one hole in the femur and two separate holes in the tibia. This was done in an attempt to duplicate the anatomic insertion of the anterior cruciate ligament on the tibia, to increase the strength of the tendon graft, and to reconstruct the anterior and posterior bundles of the anterior cruciate ligament. The follow-up period ranged from two and one-half to five years (average, 3.6 years). Before surgery, all patients complained of varying degrees of pain. Four were not able to participate in sports, seven had pain on walking, and nine complained of recurrent swelling. Lachman's test was positive in 14 patients; anterior drawer test was 3+ in ten patients and 2+ in four patients; and pivot shift test was positive in 13 patients. Anteromedial instability of 1+ was present in five patients; combined straight, anteromedial, and posterolateral instability in four patients; and anterolateral in one patient. Ten patients sustained a tear of the medial meniscus, two of the medial and lateral menisci, and one of the lateral meniscus. Chondromalacia and degenerative changes of the knee were noted in nine patients. After operation, four patients complained of aching sensation during weather changes and two of aching in the patellar region after strenuous sports activities. The Lachman test was negative in 11 patients and was less than 1+ in three patients. The anterior drawer test was negative in four patients, trace in two patients, less than 1+ in five patients, and 1+ in three patients. The pivot shift test was negative in all patients. All patients were able to return to their previous occupations; eight patients were able to participate in recreational sports and one in intercollegiate soccer. Using a standard rating system, after operation 12 patients were rated as excellent or good and two as fair (+).