{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T00:41:14Z","timestamp":1760920874357,"version":"build-2065373602"},"reference-count":30,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2015,1,29]],"date-time":"2015-01-29T00:00:00Z","timestamp":1422489600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2015,1,29]],"date-time":"2015-01-29T00:00:00Z","timestamp":1422489600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>This case\u2010series outcome study presents a surgical technique for anatomic double\u2010bundle anterior cruciate ligament (ACL) reconstruction with 4\u2010tunnel using two interference screws. There was a 2\u2010year minimum follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From January to December 2009, an ACL 4\u2010tunnel, anatomic, double\u2010bundle reconstruction was performed on 27 patients. Double\u2010strand hamstring tendon grafts were used in each femoral tunnel as well as two interference screws. Tibial fixation was insured through manual tension, by tying non\u2010absorbable sutures on the bone bridge between the two tunnels at 20\u00b0 of knee flexion. Clinical assessments included the International Knee Documentation Committee (IKDC) and Lysholm knee scores, range of motion (ROM), pivot\u2010shift test, single\u2010leg hop, and quadriceps\u2010hamstrings strength tests using a hand\u2010held dynamometer. Anterior knee laxity was also assessed using a rolimeter. A single examiner performed all testing pre\u2010operatively at 6\u00a0months and during the 2\u2010year follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All patients were assessed during the 2\u2010year follow\u2010up. At that time, 92 % of the patients presented normal anterior laxity (average, 1.3 \u00b1 0.5\u00a0mm) and rotational knee stability. No statistical side\u2010to\u2010side difference was found for ROM, muscle strength, single\u2010leg hop, and function (n.s.). All patients presented a normal knee function according to the IKDC and the Lysholm score. In addition, no infection, graft failure, or pain were observed at the harvesting site.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The study shows that satisfactory results in relation to knee laxity, function, and strength can be achieved with the implant\u2010free tibial fixation in the ACL double\u2010bundle reconstruction with two interference screws.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Therapeutic case series, Level IV.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-014-3430-6","type":"journal-article","created":{"date-parts":[[2015,1,28]],"date-time":"2015-01-28T09:56:55Z","timestamp":1422439015000},"page":"2831-2837","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["A new technique in double\u2010bundle anterior cruciate ligament reconstruction with implant\u2010free tibial fixation"],"prefix":"10.1002","volume":"24","author":[{"given":"Sylvio Noronha","family":"Sacramento","sequence":"first","affiliation":[{"name":"Clinic of Fractures\/Pro\u2010ortopedia S\u00e3o Paulo SP Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eduardo","family":"Magalh\u00e3es","sequence":"additional","affiliation":[{"name":"Instituto Eduardo Magalh\u00e3es S\u00e3o Paulo SP Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pascal","family":"Christel","sequence":"additional","affiliation":[{"name":"Habib Medical Center Olaya Riyadh Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheila","family":"Ingham","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery University of Pittsburgh Medical Center Pittsburgh PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thiago Yukio","family":"Fukuda","sequence":"additional","affiliation":[{"name":"Santa Casa de 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