带髌骨块股四头肌腱嵌压固定法重建前十字韧带(附14例初步报告)

目的探讨关节镜下带髌骨块股四头肌腱嵌压固定法重建ACL的疗效。方法采用自体带髌骨块的股四头肌腱嵌压固定法,重建ACL14例,男9例,女5例。左8例,右6例。年龄16~38岁,平均25岁。交通事故伤6例,运动伤6例,膝关节扭伤2例。取同侧髌骨块11mm×10mm股四头肌腱长6~8cm,直径7~8mm,肌腱断端编织缝合。采用阶梯钻一次成型股骨端隧道,呈倒置的瓶颈状。将肌腱从股骨外髁隧道口牵入胫骨隧道外口,骨块肌腱复合材料嵌入瓶颈状股骨隧道内,肌腱编织线在胫骨桥上交叉打结屈膝30°固定,术后支具制动。结果术后随访平均9个月,采用Lysholm膝关节功能评分,术前平均63.5分,终末随访平均94.5分,术后提高31分。Rulermetr测试胫骨位移距离,术后位移≤3mm者12例,≤5mm者2例。Lachman试验和抽屉试验阴性12例,弱阳性2例。膝关节稳定,屈伸功能及活动度正常。结论带髌骨块股四头肌腱移植嵌压固定重建十字交叉韧带固定牢固,有利于腱骨愈合。免用高值耗材。     

保留交叉韧带前内侧束或后外侧束与残端重建ACL的价值

[目的]探讨保留交叉韧带(anterior erueiate ligament,ACL)部分束支与残端纤维对前交叉韧带(ACL)重建的价值.[方法]前交叉韧带损伤89例,其中运动伤32例,训练伤24例,交通事故伤23例,生活中扭伤10例.关节镜下发现ACL在股骨髁间窝处断裂24例,胫骨髁间止点断裂28例,ACL前内侧束(AMB)断裂14例,后外侧束(PLB)断裂23例.采用保留ACL残端四股胭绳肌腱结嵌压固定法重建32例,自体带髌骨块的股四头肌腱嵌压固定法重建20例;保留ACL前内侧束和后外侧束双股胭绳肌腱结嵌压固定重建37例.胫骨端采用界面钉固定和在胫骨桥上肌腱缝线打结固定.[结果]术后均得到随访,时间14～37个月,平均25个月,术后膝关节稳定性增强,Lysholm膝关节功能评分,术前平均67.5分,终末随访平均95.2分,术后提高27.7分.Rulermetr测试胫骨位移距离4 mm±3 mm 72例,6 mm±2 mm 17例;Lachman试验阴性79例,弱阳性8例,阳性2例.按膝关节疗效评定标准,优76例,良13例.[结论]保留交叉韧带前内侧束或后外侧束与残端重建ACL,有助于移植肌腱再血管化及爬行替代和本体感觉建立,有利于维持膝关节稳定性.     

肌腱结嵌压固定法重建前交叉韧带生物力学实验研究

目的探讨绳肌腱结嵌压固定法重建前交叉韧带(ACL)影响初始固定效果的相关因素及对策。方法采用猪膝关节模拟重建ACL不同术式,即绳肌腱结股骨隧道嵌压固定和胫骨端肌腱编织缝合骨桥打结固定法,与骨-髌腱-骨两端界面螺钉固定法,比较其生物力学初始固定最大拔出载荷、抗拉刚度和位移等生物力学指标。结果最大抗拉载荷肌腱结组与正常ACL组接近,无显著性差异;肌腱结组大于骨-髌腱-骨界面螺钉固定组。抗拉载荷在100N和400N时的位移两组无显著性差异。胫骨端肌腱编织缝合骨桥上打结固定组最大抗拉载荷大于BPTB界面螺钉固定组和肌腱编织缝合后界面螺钉固定组。抗拉刚度正常ACL组>骨-髌腱-骨组>绳肌腱结组。最大位移正常ACL<髌腱骨组<肌腱结组。结论绳肌腱结嵌压固定法抗拉强度和刚度完全可以满足重建后ACL的生理需求;术中克服位移因素,是有效防止ACL重建术后松弛的关键。     

肌腱结嵌压固定保留胫骨止点的腘绳肌腱重建前交叉韧带

目的：探讨以自体骨栓肌腱结嵌压固定保留胫骨止点的胭绳肌腱重建膝前交叉韧带的临床效果及应用价值。方法：采用自体骨栓肌腱结嵌压固定保留胫骨止点的胭绳肌腱重建膝前交叉韧带断裂20例,男15例,女5例;年龄18～32岁,平均22岁;左、右膝各10例。取自体胭绳肌腱,保留肌腱的胫骨止点,两端编织缝合后预张。建立胫骨、股骨隧道,并制作胫骨骨桥结构,股骨隧道为内窄外宽结构。骨栓肌腱结嵌入股骨隧道内,牵引线带着肌腱结远端的腱束经股骨、胫骨隧道穿出,与胫骨止点上的肌腱交叉,在胫骨骨桥上打结并缝合固定。术后患膝以支具固定在屈曲45。位。结果：20例患者均获得随访,随访时间8—24个月,平均11个月。膝关节功能评估采用Lysholm功能评分标准,术前平均（61．5±4．6）分,终末随访时平均（92．5±3．7）分,差异有统计学意义,P〈0．05。结论：骨栓肌腱结嵌压固定保留胫骨止点的胭绳肌腱重建膝前交叉韧带的方法为生物学固定,避免使用高值耗材,降低了手术费用,且有利于腱-骨愈合。     

肌腱结嵌压固定保留胫骨止点的胭绳肌腱重建前交叉韧带

目的：探讨以自体骨栓肌腱结嵌压固定保留胫骨止点的胭绳肌腱重建膝前交叉韧带的临床效果及应用价值。方法：采用自体骨栓肌腱结嵌压固定保留胫骨止点的胭绳肌腱重建膝前交叉韧带断裂20例，男15例，女5例；年龄18～32岁，平均22岁；左、右膝各10例。取自体胭绳肌腱，保留肌腱的胫骨止点，两端编织缝合后预张。建立胫骨、股骨隧道，并制作胫骨骨桥结构，股骨隧道为内窄外宽结构。骨栓肌腱结嵌入股骨隧道内，牵引线带着肌腱结远端的腱束经股骨、胫骨隧道穿出，与胫骨止点上的肌腱交叉，在胫骨骨桥上打结并缝合固定。术后患膝以支具固定在屈曲45。位。结果：20例患者均获得随访，随访时间8—24个月，平均11个月。膝关节功能评估采用Lysholm功能评分标准，术前平均（61．5&#177;4．6）分，终末随访时平均（92．5&#177;3．7）分，差异有统计学意义，P〈0．05。结论：骨栓肌腱结嵌压固定保留胫骨止点的胭绳肌腱重建膝前交叉韧带的方法为生物学固定，避免使用高值耗材，降低了手术费用，且有利于腱-骨愈合。     

关节镜下自体腘绳肌腱重建前交叉韧带的康复与护理

[目的]对关节镜下胭绳肌腱结嵌压固定重建前交叉韧带（ACL）的康复与护理进行探讨。[方法]对14例ACL损伤行关节镜下胭绳肌腱结嵌压固定重建ACL的患者，分为4个阶段进行指导：术前指导、术后护理、术后功能锻炼、出院指导。[结果]14例患者得到随访，关节稳定，功能恢复正常。采用Lysholm膝关节功能评分，术前平均63．5分，终末随访平均94．5分，术后提高31．0分。[结论]阶段指导可操作性和针对性强，规范的康复护理为术后膝关节功能恢复提供了强有力的保证，有效促进关节镜TIN绳肌腱结嵌压固定重建ACL的功能康复。     

肌腱结嵌压双股腘绳肌腱重建前交叉韧带的动物实验模型:体外生物力学性能测定

目的 :建立肌腱结嵌压双股腘绳肌腱重建前交叉韧带 (ACL)的动物实验模型 ,对重建早期的生物力学性能进行测定和评价。方法 :在猪膝关节的股骨端 ,用自行设计的联合阶梯状钻头在与股骨干纵轴成 45°角向股骨髁间窝 1 1点处钻一瓶颈状骨性隧道。腘绳肌腱中间打结后并成双股穿过骨性隧道 ,肌腱结在隧道的阶梯处形成嵌压。测定肌腱结在骨性隧道内可承受的最大载荷和负载时的位移量。对照组用骨-髌腱-骨 (B PT B)进行ACL重建。结果 :肌腱结嵌压组可承受的最大载荷为 ( 680± 1 3 0 )N ,>B PT B组的 ( 4 59± 1 47)N (P <0 .0 1 )。在 40 0N的生理载荷下 ,肌腱结嵌压重建ACL产生的位移量为 ( 9.85± 2 .96)mm ,B PT B组为 ( 7.49± 2 .67)mm ,两组之间没有明显差异 (P >0 .0 5)。结论 :肌腱结在骨性隧道内的嵌压具有良好的生物力学性能 ,可以满足前交叉韧带重建的生物力学需要。     

腘绳肌腱结嵌压固定法重建交叉韧带的临床应用与生物力学研究

目的探讨腘绳肌腱结嵌压固定法重建交叉韧带的可行性。方法对52例陈旧性前、后交叉韧带损伤患者在关节镜下行双股腘绳肌腱中间打结,嵌入瓶颈状股骨隧道内固定,胫骨端采用肌腱编织缝合在骨桥上打结固定,重建交叉韧带。其中前交叉韧带25例,前、后十字韧带同时重建15例,后交叉韧带12例。生物力学实验采用猪膝关节。股骨端固定分为肌腱结嵌入组(n=13)和骨髌腱骨(B PT B)介面螺钉固定组(B PT B介面钉组,n=11)。胫骨端固定分为肌腱编织缝合线在骨桥打结组(n=7)、肌腱编织缝合介面螺钉组(n=8)。进行最大拔出强度、最大位移和固定刚度等力学实验。结果术后随访49例,平均14 6个月,Lanchman试验阴性46例,阳性3例。术后Lysholm评分由术前56 7分提高到92 8分。按膝关节疗效评定标准,优46例,良3例。生物力学实验最大拔出强度肌腱结嵌入组高于B PT B介面钉组;固定刚度肌腱结嵌入组小于B PT B介面钉组;最大位移肌腱结嵌入组大于B PT B介面钉组。胫骨端固定抗拉强度和刚度骨桥打结组优于介面螺钉组。结论腘绳肌腱结嵌压固定重建交叉韧带生物力学抗拉强度能满足生理需求,方法可行;可克服位移因素,降低韧带松弛率,提高疗效。     

Guo绳肌腱结嵌压固定法重建交叉韧带的临床应用与生物力学研究

目的探讨Guo绳肌腱结嵌压固定法重建交叉韧带的可行性。方法对52例陈旧性前、后交叉韧带损伤患者在关节镜下行双股Guo绳肌腱中间打结，嵌入瓶颈状股骨隧道内固定，胫骨端采用肌腱编织缝合在骨桥上打结固定，重建交叉韧带。其中前交叉韧带25例，前、后十字韧带同时重建15例，后交叉韧带12例。生物力学实验采用猪膝关节。股骨端固定分为肌腱结嵌入组(n=13)和骨-髌腱-骨(B-PT-B)介面螺钉固定组(B-PT-B介面钉组，n=11)。胫骨端固定分为肌腱编织缝合线在骨桥打结组(n=7)、肌腱编织缝合介面螺钉组(n=8)。进行最大拔出强度、最大位移和固定刚度等力学实验。结果术后随访49例，平均14．6个月，Lanchman试验阴性46例，阳性3例。术后Lysholm评分由术前56．7分提高到92．8分。按膝关节疗效评定标准，优46例，良3例。生物力学实验最大拔出强度：肌腱结嵌入组高于B-PT-B介面钉组；固定刚度肌腱结嵌入组小于B-PT-B介面钉组；最大位移肌腱结嵌入组大于B-PT-B介面钉组。胫骨端固定抗拉强度和刚度骨桥打结组优于介面螺钉组。结论Guo绳肌腱结嵌压固定重建交叉韧带生物力学抗拉强度能满足生理需求，方法可行；可克服位移因素，降低韧带松弛率，提高疗效。     

肌腱结嵌压双股腘绳肌腱重建前交叉韧带的体外生物力学性能测定

目的　评价肌腱结嵌压双股绳肌腱重建前交叉韧带 (ACL)的体外生物力学性能。方法　在猪膝关节的股骨端 ,用联合阶梯状钻头在与股骨干纵轴成 4 5°角向股骨髁间窝 11点处钻一瓶颈状骨性隧道。绳肌腱中间打结后并成双股穿过骨性隧道 ,肌腱结在隧道的阶梯处形成嵌压。测定肌腱结可承受的最大载荷和负载时的位移量。对照组分别用骨 -髌腱 -骨 (B -PT-B)界面螺钉和游离肌腱 (FT)界面螺钉进行ACL重建。结果　肌腱结嵌压组可承受的最大载荷为 6 80± 130N ,大于B -PT -B组的 4 5 9± 14 7N (P <0 0 1)和FT组的 15 1± 34N (P <0 0 0 1)。在 4 0 0N的生理载荷下 ,肌腱结嵌压重建ACL产生的位移量为 9 85± 2 96mm ,B -PT -B组为 7 4 9± 2 6 7mm ,两组之间没有明显差别 (P >0 0 5 )。结论　肌腱结在骨性隧道内的嵌压具有良好的生物力学性能 ,可以满足前交叉韧带重建的生物力学需要     

关节镜下横穿钉固定重建膝关节前交叉韧带的临床疗效分析

[目的]观察关节镜下股骨侧应用横穿钉(Transfix)固定,胫骨侧界面螺钉(Interference)结合门型钉固定自体腘绳肌腱或同种异体肌腱重建膝关节前交叉韧带的临床疗效。[方法]膝关节前交叉韧带重建患者117例,所有患者均应用股骨侧横穿钉(Transfix)固定,胫骨侧界面螺钉(Interference)结合门型钉固定行前交叉韧带单束重建,其中使用自体腘绳肌腱患者81例,使用同种异体肌腱患者36例,观察此固定方法的可靠性及近期疗效,使用Lysholm评分及IKDC 2000评价手术前后膝关节功能。[结果]103例患者获得随访,随访时间12～26个月(平均18个月),关节活动度正常。平均Lysholm评分由术前的(57.60±5.74)分提高到术后的(94.55±2.38)分(P0.05)。IKDC 2000评分96例正常,6例(5.8%)接近正常,1例(1%)异常。自体腘绳肌腱组和同种异体肌腱组患者的物理检查及功能评分无明显差异。[结论]股骨侧横穿钉固定,胫骨侧界面螺钉结合门型钉固定重建膝关节前交叉韧带的手术方式近期疗效肯定,移植物固定可靠,手术操作安全。应用自体及同种异体肌腱进行重建都具有良好的临床效果,可根据患者的病情及主观要求进行选择。     

腘绳肌腱结合双固定技术重建前交叉韧带

目的探讨采用腘绳肌腱股骨端胫骨端双固定技术重建前交叉韧带(ACL)的可行性及近期疗效。方法对25例ACL损伤行关节镜下ACL重建术,采用笔者自行设计双监视法解剖等长重建技术建立股骨胫骨隧道。移植物股骨端用Endobutton钢板和Rigidfix固定,胫骨端用Bio-Intrafix和Stample门形加压钉固定。结果本组获随访12～18(13.76±1.61)个月,未发现滑膜炎、韧带断裂、活动度明显障碍等并发症。根据Lysholm膝关节功能评分,术前评分:20～48(31.32±8.71)分;术后1年评分:90～98(94.96±2.56)分(t=37.69,P<0.01)。结论在腘绳肌腱重建ACL中应用股骨端胫骨端双固定技术具有手术操作简便,固定牢固,效果可靠的优点,值得推广。     

Rekonstruktion des vorderen Kreuzbandes

The treatment of ruptures of the anterior cruciate ligament (ACL) plays an essential role for both clinicians and resident physicians. To date many questions regarding the outcome as well as ACL reconstruction techniques have not yet been conclusively clarified. Whether reconstruction of the ACL protects the knee from osteoarthritis is still unproven; however, it is well known that an unstable knee joint is more vulnerable to secondary injuries, such as meniscal tears. Thus, early ACL reconstruction is recommended to minimize the risk of these secondary injuries. Three alternative sources of material for autologous ACL reconstruction are commonly utilized. An accessory hamstring (i.e. semitendinosus tendon with or without the gracilis tendon), a central strip of the patellar tendon with bone blocks and a central strip of the quadriceps tendon with or without bone block are the most common donor tissues used in autografts. Besides selection of the type of graft, the tendon diameter also plays a crucial role. Some progress has recently been made with respect to tunnel placement. The aim is to find an anatomical tunnel position. Reconstruction of both the anteromedial and the posterolateral ACL bundles helps to rebuild the anatomy of the original ACL; however, scientifically this approach did not lead to any improvement in the results. For fixation techniques a differentiation is made between aperture, extracortical and implant-free fixation. Generally, re-ruptures are less common than revisions as a result of graft ruptures due to technical mistakes during surgery. The most common mistakes concern tunnel placement and graft fixation. Also overlooked instability can have a negative influence on the outcome of ACL reconstruction.     

Anatomische vordere Kreuzbandersatzoperation mittels Semitendinosus- und Grazilissehne in fremdmaterialfreier Press-fit-Technik

An innovative technique for anterior cruciate ligament (ACL) reconstruction has been developed in 1998 which allows the grafts to be fixed by press-fit to the femoral and tibial tunnel without any hardware. The semitendinosus (ST) and gracilis tendons (GT) are built into a sling by tying a knot with the tendon ends and securing the knot after conditioning by sutures. For the femoral tunnel the anteromedial porta is used. The correct anatomic position of the single femoral tunnel is checked using intraoperative lateral fluoroscopy by placing the tip of a K-wire to a point between the anteromedial and posterolateral bundle insertion sites. A femoral bottleneck tunnel is drilled to receive the knot of the tendons. The tendon loops filled the tibial tunnel without any suture material. The loops are fixed at the tibial tunnel outlet with tapes over a bone bridge. Between 1998 and 1999 a prospective randomized study (level 1) was conducted comparing this technique with a technique using bone-patellar-tendon graft and press-fit fixation without hardware. In conclusion it was found that implant-free press-fit ACL reconstruction using bone-patella-tendon (BPT) and hamstring tendon (HT) grafts proved to be an excellent procedure to restore stability and function of the knee. Using hamstring tendons (ST and GT) significantly lower donor site morbidity was noted. Kneeling and knee walking pain persisted to be significantly more intense in the BPT up to 9 years after the operation. Re-rupture rates, subjective findings, knee stability and isokinetic testing showed similar results for both grafts. This is the first level I study which demonstrates cartilage protection by ACL reconstruction as long as the meniscus is intact at index surgery, shown by bilateral MRI analysis 9 years post-operation. There was no significant difference in the average grade of chondral and meniscus lesions between BPT and HT and in comparison of the operated to the intact knee, except for grade 3-4 lesions found at the 9 year follow-up, which were significantly higher in the BPT group.     

保留韧带残端的自制台阶样联合钻手术系统在腘绳肌腱结嵌入固定法重建前交叉韧带中的应用

目的探讨保留韧带残端的自制台阶样联合钻手术系统在胭绳肌腱结嵌入固定法重建前交叉韧带（ACL）中应用的可行性。方法对16例ACL损伤患者采用自体半腱肌、股薄肌腱中间打结、股骨端嵌入挤压固定法镜下重建ACL。股骨隧道采用保留韧带残端的自制台阶样联合钻手术系统建立。保留原有的ACL残端。将肌腱从股骨隧道的近端经关节腔牵人胫骨隧道,将肌腱拉紧、膝关节屈伸活动20次,使肌腱结完全嵌入瓶颈状股骨隧道内。将4股肌腱从胫骨隧道和其下方10mm处分别穿出,交叉打结并缝合固定在骨桥上。结果16例均获随访,时间6～18（10±3．85）个月。根据Lysholm膝关节功能评分：术前20-55（34．36±11．16）分;术后6个月81～97（89．44±4．62）分,术前术后比较差异有显著性（t=26．07,P〈0．01）。未见滑膜炎、韧带断裂、活动明显受限等并发症。结论保留韧带残端的自制台阶样联合钻手术系统具有台阶样股骨隧道建立准确、手术操作简单、使用方便等优点,值得临床推广应用。     

Hamstring insertion site healing after anterior cruciate ligament reconstruction in patients with symptomatic hardware or repeat rupture: a histologic study in 12 patients

Purpose:Our goal was to characterize the type of biologic anchor of hamstring tendons to the femoral tunnel in cases of transfixion fixation for the anterior cruciate ligament (ACL) reconstruction. The histologic bone-hamstring tendon anchorage is not yet clearly understood despite many experimental and some clinical studies. It constitutes the weak point of the ACL reconstruction. The type of fixation, either distant from the joint such as transfixion fixation or at the tunnel entrance such as aperture fixation will determine a specific tendon-bone healing process.Type of study:Histological study.Methods:We performed ACL reconstruction with 4 strands of semitendinosus and gracilis tendons fastened by a transfixion fixation. Femoral fixation was secured by transfixion (Transfix; Arthrex, Naples, CA) and tibia fixation by a biodegradable interference screw and 2 staples. Between 3 and 20 months after surgery, we performed 12 hamstring tendon biopsies (in 9 men and 3 women; mean age, 29 years). Biopsies were performed 2 cm from the femoral outlet in 10 patients undergoing hardware removal or by coring the femoral tunnel in 2 cases of repeat rupture. In 8 cases, the femoral device was removed for persistent lateral pain, in 2 cases for instability of the hardware, and in 2 cases a repeat rupture of the graft occurred. The samples were taken by coring a tunnel 5 mm in diameter, with a tubular harvester, along the femoral Transfix axis. Each fragment was stained with H&E, Solochrome cyanine, or Masson-trichrome, and microscopical examination was performed, including polarized light.Results:At 3 months (in 1 case), a fibrovascular interface was seen between the tendon and uncalcified osteoid with very few collagen fibers. At 5 and 6 months (in 2 cases), some Sharpey-like fibers and less immature woven bone was seen. Maturity of the secondary insertion was seen after at least 10 months in 5 cases. In 2 cases, no contact was seen at the biopsy site despite good clinical stability. The 2 remaining cases underwent repeat rupture at the midsubstance of the graft at 12 and 17 months after surgery. In the first case, the tendon-bone fixation was limited at the outlet of the femoral tunnel with no fixation inside the tunnel. In the second case, the fixation was continuous with Sharpey fibers along the tunnel.Conclusions:According to our histologic results in patients, the time to obtain a mature indirect anchorage at the top of the tunnel was 10 to 12 months, which is much longer than in reported animal models (6 to 24 weeks). To our knowledge, this is the first clinical study reporting the histologic type of femoral ligament insertion 2 cm from the outlet of the tunnel with hamstring autograft for ACL reconstruction.     

关节镜下横杆式固定重建膝前十字韧带的中期疗效观察

目的 评价关节镜下自体腘绳肌腱移植、横杆式固定(transfix)重建膝关节前十字韧带(anterior cruciate ligament,ACL)的中期临床疗效.方法 自2002年8月至2003年12月对38例膝关节ACL断裂患者应用自体腘绳肌腱重建ACL、股骨端采用横杆式固定、胫骨端采用界面螺钉固定.男21例,女17例;年龄19～48岁,平均28.4岁;左膝24例,右膝14例.运动伤27例,交通伤2例,跌倒扭伤2例,余7例无明显外伤.急性损伤6例,陈旧性损伤32例.术前体检:前抽屉试验阳性35例,弱阳性1例,阴性2例;Lachman征阳性37例,弱阳性1例.以Lysholm评分评价中期临床疗效,以MRI及X线观察移植物以及骨隧道变化情况.结果 38例患者中36例获得随访(随访率94.7％),随访时间6.3～7.6年,平均6.8年.所有患者关节活动度正常,Lysholm评分由术前(64.4±4.52)分提高到(85.6±4.60)分,差异有统计学意义.X线及MRI发现3例股骨及胫骨隧道均扩大,5例股骨隧道扩大,3例胫骨隧道近端扩大.未见关节间隙变窄.1例患者在术后4年因外伤再次致ACL断裂,行关节镜下ACL翻修术,采用同种异体肌腱移植物,股骨端及胫骨端采用可吸收挤压钉固定.结论 应用腘绳肌腱、股骨侧横杆式、胫骨侧界面挤压螺钉固定重建膝关节ACL可以获得较为满意的关节活动度及关节稳定性,中期疗效佳.     

Rekonstruktion des vorderen Kreuzbandes

Rupture of the anterior cruciate ligament (ACL) is a common acute injury representing a pre-arthrotic deformity whether treated surgically or not. Surgical treatment in actively sportive patients with instability should be prompt. The most frequently used transplantations include hamstring tendons and the middle third patellar tendon. Both transplantats achieve good results, although the hamstring tendons produce less donor site morbidity. The standard surgical technique is the 1-bundle reconstruction with anatomic positioning of the bone tunnel. The femoral tunnel should be placed over the anteromedial portal, to enable a lateral position. Fixation should be close to the joint without damaging the transplant. Hybrid fixation with the hamstring transplant seems to achieve the best primary stability.