Ricostruzione anatomica del legamento crociato anteriore con passaggio in posizione over the top dei tendini di gracile e semitendinoso

Double bundle ACL reconstruction using hamstrings allows a more anatomic result and permits to avoid the use of hardware for graft fixation. Hamstrings tendons are harvested maintaining their tibial insertion intact. Tibial tunnel is positioned at the middle-posterior portion of native ACL tibial insertion. Regarding femoral tunnel, the guidepin is introduced from the AM arthroscopic portal to 10 o' clock position in the medial wall of the lateral condyle and it passes through the lateral femoral cortex. The correct exit point on the lateral femoral cortex has to be positioned just superior to lateral femoral condyle origin. Graft is first passed in over the top position. The correct position is found palpating with a finger the lateral femoral condyle tubercle. Suture wires at the free extremities of harvested tendons are charged on a guide wire which is retracted into the knee in over the top position. Using a suture carrier through AM portal, another suture wire is taken into the joint and then retracted outside through the femoral tunnel. Suture wires at the free extremities of the graft are tied again on the messenger wire, which is finally retracted through the femoral tunnel, the joint space and the tibial tunnel, so that the graft finally comes out from the tibial incision. The graft is then tensioned and fixed with a transosseous knot. This technique wants to reproduce the kinematic effect of antero-medial and postero-lateral bundle of the ACL.