Evaluation of Arthroscopic ACL Reconstruction by 3 different Techniques
Amit Ahluwalia1, Atul Mishra2, Rajul Rastogi3* and Pallavi Ahluwalia4
1Senior Consultant Orthopedics, Moradabad, UP, India
2Senior Consultant Orthopedics, Fortis Hospital, Noida, UP, India
3Associate Professor, Department of Radiodiagnosis, Teerthanker Mahaveer Medical College & Research Center, Moradabad, India
4Professor Department of Anesthesia, Teerthanker Mahaveer Medical College & Research Center, Moradabad, India
Submission: April 30, 2018; Published: May 31, 2018
*Corresponding author: Rajul Rastogi, Associate Professor, Department of Radiodiagnosis, Teerthanker Mahaveer Medical College & Research Center, Moradabad, Uttar Pradesh, India, Email: email@example.com
How to cite this article: Amit A, Atul M, Rajul R, Pallavi A. Evaluation of Arthroscopic ACL Reconstruction by 3 different Techniques. Ortho & Rheum Open Access J 2018; 12(1): 555827. DOI: 10.19080/OROAJ.2018.12.555827.
In the present era of increased human activity and trauma, more and more incidences of knee injuries especially anterior cruciate ligament are coming for medical work-up. With the recent development in imaging and arthroscopic techniques many approaches have evolved for management of ACL tears. The present article evaluates the outcome of ACL reconstruction by three different arthroscopic techniques.
The goal of arthroscopic anterior cruciate ligament (ACL) reconstruction is to restore joint function by restoring normal knee kinematics. Biomechanical studies have demonstrated that single bundle ACL reconstruction is insufficient for controlling rotation in extension. Double bundle ACL reconstruction has been shown to provide more improvement in knee stability theoretically because it more closely mimics the anatomic structure of ACL.
A growing body of literature has consistently reported a
safe, well tolerated procedure with a high degree of success.
An animal model study demonstrated the effect of treating the
degenerated tendon is for a return of Type 1 and 3 collagens
return to normal concentrations and ratios at three weeks 
(Figure 6). This suggests the mechanism of cutting and removing
the degenerated tendon has a stimulatory effect on the healing
process, postulated to be facilitated by the absence of diseased
tissue that has not resorbed.
Figure 1 shows the distribution of patients according to surgical technique used. The type of reconstruction selected was dictated by the need to obtain a sufficient length of hamstring graft and affordability of the patient for the implants OTLP (Table 1).
a. STG was harvested and the insertion was sacrificed.
b. Gracilis & ST were stitched together and quadrupled.
c. A tibial tunnel was drilled up to 7-8mm depending on the
diameter of quadrupled graft.
d. A femoral guide pin was positioned at 10.30 o’clock on
the right knee and 1.30 o’clock on the left knee with 90-
110° flexion at the knee, using an appropriate offset device
inserted through the AM portal .
e. An appropriate size tunnel was prepared.
f. Manual tensioning of the graft was done by constantly
pulling the graft and subjecting the knee through a full range
of motion 10 times.
g. Femoral fixation was done using endobutton (CL,
h. Tibial fixation was done keeping the knee in 30° flexion
with metal/ bio interference screw.
For AM femoral tunnel, a 4mm over the top guide was
inserted through the AM portal keeping the knee in about 100°
of flexion and placed on the proximal cortex of the intercondylar
notch at about 11 o’clock for the right knee and 1 o’clock for the
i. The point lies roughly at the same level in horizontal plane
in relation to AM tunnel in 90° knee flexion.
ii. The center of the PL bundle footprint is approximately
located at the crossing point of the long axis line of the ACL
attachment and a vertical line drawn through the contact
point between the femoral condyle and tibial plateau at 90°
of knee flexion.
iii. The socket was placed at 9 o’clock position for the right
knee and 3 o’clock position for the left knee.
iv. The position of the guide wire was rechecked by switching
the arthroscope from anterolateral to anteromedial portal.
There was no significant difference between the 3 groups
with respect to age at the time of surgery, sex and time to
surgery (Figures 13-17). The three surgical patient groups were
compared with respect to findings of physical examination and
subjective evaluation through Cincinnati Knee score (Tables 4 &
Based on the above study analysis, it can be concluded that
the overall outcome of the three surgical repair techniques for
ACL reconstruction is nearly same except for fewer complications
that have higher incidence with single-bundle technique.
Hence, the decision of right choice is based on clinical findings,
infrastructure available and financial issues.