Double-bundle anatomic anterior cruciate ligament reconstruction using bone-hamstring-bone composite graft.

The bone-hamstring-bone (BHB) composite graft is a hybrid ligament reconstruction methodology that combines the advantages but eliminates the disadvantages of the bone-patellar tendon-bone (BPTB) and tendon of semitendinosus and gracilis muscle (STG) methods. We have developed an innovative modified BHB method involving anatomic anterior cruciate ligament (ACL) reconstruction. It takes into account the 2 bundles of the ACL: the anteromedial bundle and the posterolateral bundle. The composite graft was prepared by folding the gracilis and the semitendinosus tendons twice and flanking the ends by bone blocks obtained from the tibia. One tunnel of 11-mm diameter was made in the tibia and the femur, and the top of the graft was introduced into the femoral socket; the distal end of the graft was rotated 90 degrees in the counterclockwise direction for a right knee and 90 degrees in the clockwise direction for a left knee to apply a twist to the graft, giving rise to an anteromedial bundle and a posterolateral bundle. The bone blocks attached to the graft were fixed with 2 interference screws. Modified BHB technique allows free selection of the location of the bone plug, minimizes the intra-articular length of the graft, and maintains the double-bundle structure of the original ACL.