Background: Recent years have seen anterior cruciate ligament (ACL) reconstruction being performed in a broad\r\nrange of patients, regardless of age, sex and occupation, thanks to great advances in surgical techniques, surgical\r\ninstruments and basic research. In cases of ACL reconstruction, bone-patellar tendon-bone (BTB) graft or hamstring\r\ngraft are frequency used. However, potential complications associated with tunnel enlargement due to soft tissue\r\ngraft such as hamstring were reported. On the other hand, an altered rotational axis resulting in significantly\r\ngreater translation of the lateral compartment in the single bundle compared with double bundle ACL\r\nreconstruction was reported.\r\nMethod and procedure: A reconstruction procedure was modified for the ACL using a double bundle that is the\r\ncombination of BTB and gracilis tendon composite autograft. Two tibial and two femoral bone tunnels are used to\r\nreconstruct two bundles of ACL; an anteromedial bundle (AMB) and a posterolateral bundle (PLB). The femoral\r\nbone tunnels are created just posterior to the resident�s ridge. The tibial bone tunnels are created at the center of\r\nAM and PL tibial attachment, respectively. BTB is fixed in the AM tunnels produced on the anatomical points of\r\ntibia and femur. The gracilis graft is fixed in an anatomical PL tunnel produced. The mean width of BTB is 7 mm,\r\nsince10 mm graft is sometimes not suitable for patients, especially small Asian people and females. For these\r\npatients, 10 mm graft is bigger than one third of patella tendon width.\r\nConclusion: The devised surgical procedure based on a combination of BTB and gracilis autograft is suitable\r\nreconstruction method for patients who have small or medium width of patellar tendon such as Asian people and\r\nfemales. This technique is also applicable to revision surgery.
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