Objective: Partial augmentation of isolated tears of the anteromedial and posterolateral bundle of the anterior cruciate ligament (ACL) with autologous hamstring tendons. The intact fibers of the ACL are preserved.
Indications: Symptomatic isolated tear of the anteromedial or posteromedial bundle of the ACL or rotational instability after ACL reconstruction with malplaced tunnels (e.g., high femoral position)
Contraindications: In revision cases: loss of motion due to malplaced ACL and excessive tunnel widening of the present tunnels with the risk of tunnel confluence.
Surgical technique: Examination of anterior-posterior translation and rotational instability under anesthesia. Diagnostic arthroscopy, repetition of the clinical examination under direct visualization of the ACL, meticulous probing of the functional bundles. Resection of ligament remnants, preparation/preservation of the femoral and tibial footprint. Harvesting one of the hamstring tendons, graft preparation. Positioning of a 2.4 mm K-wire in the anatomic center of the femoral anteromedial/posterolateral bundle insertion, cannulated drilling according to the graft diameter. Positioning of a 2.4 mm K-wire balanced according to the femoral tunnel at the tibia, cannulated drilling. Insertion of the graft and fixation.
Postoperative management: Analogous to that for ACL reconstruction.