Modified technique of ACLR with Dual Tibial Fixation Octuple Hamstring Graft: A Study of 50 Cases

Abstract

Background: Anterior cruciate ligament reconstruction (ACLR) is commonly performed in symptomatic patients with ACL tears, particularly in individuals involved in sports and physically demanding activities. Secure graft fixation and maintenance of appropriate graft tension are essential for restoring knee stability and reducing the risk of postoperative laxity and graft failure. Tibial fixation remains an important component of ACL reconstruction because inadequate fixation or loss of graft tension may contribute to residual instability. Objective: To describe a simple, cost-effective technique of dual tibial fixation using a suture disc washer in ACL reconstruction with a hamstring graft, with emphasis on maintaining graft tension and achieving secure tibial fixation. Technique: The technique utilizes a suspensory femoral fixation device and dual tibial fixation with a 2-hole conical suture disc washer. Following arthroscopic ACL reconstruction and femoral fixation, the graft is tensioned through repeated knee flexion-extension cycles. Tibial fixation is subsequently performed at approximately 30° of knee flexion by securing the graft sutures to the suture disc washer with multiple knots. The suture disc provides additional fixation at the tibial tunnel aperture and facilitates maintenance of graft tension. Results: The technique was used in 50 patients undergoing ACL reconstruction. The procedure provided an additional point of tibial fixation and allowed controlled tensioning of the graft during tibial fixation. The suture disc also covered the tibial tunnel aperture and the fixation construct, potentially reducing direct prominence of the fixation material beneath the skin. Conclusion: The described dual tibial fixation technique is a simple and cost-effective method for securing the ACL graft while maintaining graft tension. The use of a suture disc washer provides additional tibial fixation and may be particularly useful when secure graft fixation and protection of the tibial tunnel aperture are desired. Further comparative studies with larger patient populations and objective clinical and biomechanical assessment are required to establish its effectiveness.

Keywords: Anterior cruciate ligament reconstruction; ACL tear; hamstring graft; tibial fixation; suture disc; graft tension; arthroscopy.