The successful outcome in ACL reconstruction, whether single or double bundle depends largely on the technique and the quality of the graft used. Less number of strands may not provide adequate strength, and more strands may cause overcrowding and impingement. This study was conducted to find out the adequate number of graft strands which could provide the needed strength without causing impingement in Indian population.
In this prospective and comparative interventional study 120 patients of age between 18 and 50 yrs with clinically documented unilateral ACL injury, confirmed by arthroscopy were included. Multistranded hamstring graft (SHG) was used in all the cases as ACL substitute. The fixation method on the femoral side was titanium Endobutton with continuous loop mersilene tape and on the tibial side bioabsorbable screws were used. Decision to do 6SHG or 4HGH was based on the graft diameter and length obtained intraoperatively.
The two different techniques, we compared viz. the 6SHG and 4SHG techniques provided excellent results in terms of knee stability, but 6SHG technique provided slightly better result than the 4SHG group in terms of IKDC scoring, though not significant statistically. There was no significant difference between the techniques in terms of modified Lysholm’s score. Both techniques were comparable in terms of clinical laxity and subjective scores though instrumental laxity measurement showed better knee stability in Double bundle ACL reconstruction.
Diameter of graft should decide which technique to choose. If Gracilis tendon diameter is more than 5 mm, 4SHG is recommended and if less than 5 mm and semi T length more than 280 then 6SHG should be preferred. In cases with Gracilis diameter less than 5mm and Semitendinosus length less than 280mm, double bundle technique was not considered suitable and anatomical single bundle reconstruction should be done.