Simultaneous Bilateral ACL Reconstruction:A Safe Option

Saithna A, Arbuthnot J, Radovanovic J, Carey-Smith R, Spalding T

• Incidence of patients presenting with bilateral ACL deficiency is uncommon

• Simultaneous or staged surgery?

• Published literature

– Jari and Shelbourne, 2002 ( patella tendon autograft, n=28)

– Larson et al, 2004 (patella tendon allograft, n=11)

– Sajovic and Demsar, 2007 (hamstring tendon, n=1)

Surgeons

Assistant

Mayo table

Scrub nurse

instruments

Stack for left knee surgeon

Anaesthetist

Graft prep

• ST and Gracilis• 4 strand construct• Femoral Endobutton (Smith and Nephew, UK)• Extralok screw tibia (Linvatec UK)• Linvatec tensioner

• Patella tendon• Ipsilateral central 1/3rd

• Interference fit BioScrews (Linvatec UK)

Same principle as unilateral surgery

• Cryocuff• Flexion/extension exercises• Mobilise FWB as tolerated• Standardised rehab• No bracing

• Clinical review 2,6,12/52 and then 6 monthly• Prospectively record Tegner, Lysholm

• 8 patients (6M, 2F)

• Hamstring tendon 7 knees, Patella tendon 9

• Mean age 30.5 yrs (21-41)

• Football(9), Winter sports(5), Fall (2)

• Mean time between injuries 5.2yrs (1-11)

• Mean duration of surgery 104 mins

• 5 patients had meniscal surgery at the same sitting – 3 in both knees

• Day of discharge; day 1 (6 patients), day 2 (2 patients)

• 2 weeks: – all patients off crutches– All knees > 90 degrees flexion and full extension

• Latest f/u (mean 28 months)– Tegner 5 6.4– Lysholm 61.2 91.2

– Pivot shift Negative 15, Glide 3– Infection 0– VTE 0

• No compromise in early functional results

• Early FWB then same rehab as for unilateral ACL

• Patella tendon or hamstrings? Patient/surgeon choice

• Small series

• Reduced overall period of rehab and cost

• A safe option

• Small series – but patients have had no problems

• Reduced period of rehabilitation and reduced cost

Thank you