A New Double-Bundle Anterior Cruciate Ligament Reconstruction Using the Posteromedial Portal Technique With Hamstrings

We describe a new double-bundle reconstruction method for ruptured anterior cruciate ligament using a posteromedial portal technique. Reconstruction materials are semitendinosus tendon (STT) and gracilis tendon (GT). STT is used as the substitute for the anteromedial bundle (AMB) and fixed to the tunnels produced on the tibia and the femur. GT is used as the substitute for the posterolateral bundle (PLB) and fixed to the tunnels on the tibia and the femur. This femoral tunnel for the PLB is created through a posteromedial portal. These procedures are performed using the inside-out technique. The posteromedial portal provides an accurate access to the femoral attachment of the PLB. This surgical technique can avoid overlapping of the 2 femoral tunnels and destruction of the posterior cortex of the lateral condyle on the femur during the preparation of the PLB. Our technique does not need another tibial tunnel for the PLB; the 1 tibial tunnel enables double-bundle reconstruction and prevents tibial tunnel expansion.