Footprint Optimization in Anterior Cruciate Ligament Reconstruction: A Single Tunnel Double-bundle Approach

Objectives: Anterior cruciate ligament reconstruction is a widely performed procedure aimed at restoring knee stability and function.The study aims to investigate the feasibility, efficacy, and potential benefits of utilizing the footprint optimization single tunnel double-bundle approach in anterior cruciate ligament reconstruction surgery. Material and Methods: A total of 35 patients undergoing anterior cruciate ligament reconstruction were prospectively enrolled. Anterior cruciate ligament tunnel made using patented rectangular tunnel dilators. This rectangular tunnel optimizes the footprint of the anterior cruciate ligament, thereby mimicking a double-bundle effect with a single tunnel. Soft tissue hamstring grafts were used in all patients. The graft squeezing method was used for graft passage, with fixation achieved by suspensory ligament attachment on the femoral side and aperture fixation on the tibial side. Patient outcomes were evaluated at a mean follow-up of 3 years using passive knee range of motion (ROM), Lysholm score, International Knee Documentation Committee (IKDC) score, Lachman test for anteroposterior stability, and pivot-shift test for rotational stability. Results: The study observed encouraging results in terms of rehabilitation progress and return to activities of daily living (ADL). Passive Knee ROM exhibited a significant enhancement in knee flexion following surgery, as the average pre-operative ROM of 106 degrees increased to 134 degrees at the 36-month follow-up. ROM remained stable throughout the following years. The Lysholm knee score and IKDC scores steadily improved from a pre-operative score of 52.46±8.13 to 92.79±1.00 and 34.43±4.13 preoperatively to 86.43±0.61, respectively, at a final follow-up of 36 months. Therefore, all evaluated parameters demonstrated positive outcomes. However, one complication, a cyclops lesion was identified. Conclusion: This single-tunnel double-bundle anterior cruciate ligament reconstruction technique with a unique tunnel dilatation system and graft squeezing technique shows promising potential for achieving good functional outcomes and restoring knee stability. Long-term follow-up studies with a larger patient population are warranted to further validate these findings.