Results of simultaneous bilateral anterior cruciate ligament (ACL) reconstruction. Full paper by Saithna et al, published in KSSTA.

1. Simultaneous Bilateral ACL Reconstruction:
A Safe Option
Saithna A, Arbuthnot J, Radovanovic J, Carey-Smith R,
Spalding T

2. • 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)

3. Surgeons
Assistant
Mayo table
Scrub
nurse
instruments
Stack for
left knee
surgeon
Anaesthetist
Graft prep

6. • 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)

7. 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. • 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

9. • 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

10. • 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

11. • A safe option
• Small series – but patients have had no problems
• Reduced period of rehabilitation and reduced cost

12. Thankyou