Purpose of the study: The double-bundle technique for the reconstruction of the anterior cruciate ligament (ACL) enables anatomic repair. This reconstruction may not however be possible in all patients due to the variable quality of the graft material: insufficient length and diameter. For the double-strand hamstring technique, the diameter of the posterolateral bundle (PL) can be less than 6 mm, and for the anteromedial bundle (AM) sometimes less than 7 mm. With the bundle-strand TLS larger sized grafts can be constructed in all cases.

Material and method: We operated 15 patients with full thickness tears of the ACL. The standard TLS method was used for each strand. The semitendinous and the gracilis tendons were shaped in a closed loop into short four-strand grafts measuring 45 to 50 mm. The four tunnels were reamed retrogradely arthroscopically. The graft was fixed with mersilene tape in the tunnels and locked with four titanium screws with the knee in extension for PL and 45° for AM. The diameter of each bundle was measured. Outcome was compared with that of 15 patients treated with the double-bundle technique using hamstring tendons fixed with a femoral endobutton and a tibial screw.

Results: There were no pre- or postoperative complications in the two groups. The mean diameter of the PL bundle was 6.2 mm for the endobutton group and 7.9 mm for the TLS group (p< 0.001). The diameter of each bundle with the TLS technique was thus significantly greater in the femoral notch with no deficit in postoperative extension.

Conclusion: The TLS method has already demonstrated excellent results for the single-bundle reconstruction of the ACL. The TLS double-bundle reconstruction technique provides a quality bundle with a large diameter in all patients, irrespective of the hamstring quality. The long-term results should confirm the efficacy of this double-bundle technique.