One-stage bilateral anterior cruciate ligament reconstruction with use of hamstring tendon autografts: a case report

  • Matjaž Sajovic
Keywords: one-stage bilateral anterior cruciate ligament (ACL) reconstruction, case report, hamstrings tendons


Background: Bilateral ACL rupture is not a common clinical problem, but the incidence of the bilateral knee injuries is increasing especially within highly sports active population. Mechanism of the injury rarely causes simultaneous bilateral ACL tear. Usually unilateral injury of the knee has occurred and later on contralateral injury has taken place.

Patient and methods: Case report presented an unusual problem of a patient with chronic bilateral ACL – deficient knees and constitutionally very thin patellar tendons. Author decided to perform onestage bilateral ACL reconstructions using hamstring tendon autographs so as not too weaken his quadriceps muscles by compromising his extensor mechanism.

Results: At three years follow-up the patient’s opinion was that both ACL reconstructed knees had normal function, and he had returned to his preinjury activity level. The overall result of the Lysholm knee score for left knee was 100 and for right one 95. Both knees had full range of motion, Lachman and pivot shift signs were negative.

Conclusions: Two-stage bilateral ACL reconstruction is much more time consuming for the patient and expensive for health insurance, so one-stage bilateral ACL reconstruction is a logical solution of the problem.


Download data is not yet available.


Noyes FR, Mooar PA, Mathews DS, Butler DL. The symptomatic anterior cruciate-deficient knee. Part I: The long-term functional disability in athletically active individuals. J Bone Joint Surg 1983; 65A: 154–62.

Jacobsen K. Osteoarthritis following insufficiency of the cruciate ligaments in man. A clinical study. Acta Orthop Scand 1977; 48: 520–6.

Anderson AF, Lipscomb AB, Liudah KJ, Addlestone RB. Analysis of the intercondylar notch by computed tomography. Am J Sports Med 1987; 15: 547–52.

Jones KG. Reconstruction of the anterior cruciate ligament. A technique using the central one-third of the patellar ligament. J Bone Joint Surg 1963; 45A: 925–32.

Karlson JA, Steiner ME, Brown CH, Johnston J. Anterior cruciate ligament reconstruction using gracilis and semitendinosus tendons. Comparison of through-the-condyle and over-the-top graft placements. Am J Sports Med 1994; 22: 659–66.

Lambert KL. Vascularized patellar tendon graft with rigid internal fixation for anterior cruciate ligament insufficiency. Clin Orthop 1983; 172: 85–9.

O’Brien SJ, Warren RF, Pavlov H, Panariello R, Wickiewicz TL. Reconstruction of the chronically insufficient anterior cruciate ligament with the central third of the patellar ligament. J Bone Joint Surg 1991; 73A: 278–86.

Pinczewski LA, Deehan DJ, Salmon LJ, Russel VJ, Clingeleffer A. A five-year comparison of patellar tendon versus four-strand hamstring tendon autograft for arthroscopic reconstruction of the anterior cruciate ligament. Am J Sports Med. 2002; 30: 523–36.

Sajovic M, Vengust V, Komadina R, Tavčar R, Skaza A. A prospective, randomized comparison of semitendinosis and gracilis tendon versus patellar tendon autografts for anterior cruciate ligament reconstruction: Five years follow-up. Am J Sports Med 206; Vol 34: 1933–40.

Shelbourne KD, Gray T. Anterior cruciate ligament reconstruction with autogenous patellar tendon graft followed by accelerated rehabilitation. A two- to nine-year followup. Am J Sports Med 1997; 25: 786–95.

Wagner M, Kääb MJ, Schallock J, Haas NP, Weiler A. Hamstring tendon versus patellar tendon anterior cruciate ligament reconstruction using biodegradable interference fit fixation: A prospective Matched-Group Analysis. Am J Sports Med. 2005; 33: 1327–36.

Bonamo JJ, Krinick RM, Sporn AA. Rupture of the patellar ligament after use of its central third for anterior cruciate reconstruction. A report of two cases. J Bone Joint Surg 1984; 66A: 1294–7.

Marumoto JM, Mitsunaga MM, Richardson AB, Medoff RJ, Mayfield GW. Late patellar tendon ruptures after removal of the central third for anterior cruciate ligament reconstruction: A report of two cases. Am J Sports Med 1996; 24: 698–701.

Mastrokalos DS, Springer J, Siebold R, Paessler HH. Donor site morbidity and return to the preinjury activity level after anterior cruciate ligament reconstruction using ipsilateral and contralateral patellar tendon autograft. Am J Sports Med 2005; 33: 85–93.

Coombs R, Cochrane T. Knee flexor strength following anterior cruciate ligament reconstruction with the semitendinosus and gracilis tendons. Int J Sports Med 2001; 22: 618–22.

West RV, Harner CD. Graft selection in anterior cruciate ligament reconstruction. J Am Acad Orthop Surg 2005; 13: 197–207.

Rowden NJ, Sher D, Rogers GJ, Schindhelm K. Anterior cruciate ligament graft fixation: Initial comparison of patellar tendon and semitendinosus autografts in young fresh cadavers. Am J Sports Med 1997; 25: 472–8.

Harmon KG, Ireland ML. Gender differences in noncontact anterior cruciate ligament injuries. Clin Sports Med 2000; 19: 287– 302.

Ochard J, Seward H, McGiven J, Hood S. Intrinsic and extrinsic risk factors for anterior cruciate ligament injury in Australian footballers. Am J Sports Med 2001; 29: 196–200.

Lephart SM, Ferris CM, Fu FH. Risk factors associated with noncontact anterior cruciate ligament injuries in female athletes. Instr Course Lect 2002; 51: 307–10.

Lombardo S, Sethi PM, Starky C. Intercondylar notch stenosis is not risk factor for anterior cruciate ligament tears in professional male basketball players. An 11-year prospective study. Am J Sports Med 2005; 33: 29–34.

Flynn RK, Pedersen CL, Birmingham TB, Kirkley A, Jackowski D, Fowler PJ. The familial predisposition toward tearing the anterior cruciate ligament. A case control study. Am J Sports Med 2005; 33: 23–28.

Anderson AF, Snyder RB, Lipscomb AB Sr. Anterior cruciate ligament reconstruction using the semitendinosus and gracilis tendons augmented by the Losee iliotibial band tenodesis: A longterm study. Am J Sports Med 1994; 22: 620–6.

Souryal TO, Moore HA, Evans JP. Bilaterality in anterior cruciate ligament injuries: Associated intercondylar notch stenosis. Am J Sports Med 1988; 16: 449–54.

Jari S, Shelbourne KD. Simultaneous bilateral anterior cruciate ligament reconstruction. Am J Sports Med 2002; 30: 891–5.

Larson CM, Fischer DA, Smith JP, Boyd JL. Bilateral anterior cruciate ligament reconstruction as a single procedure. Evaluation of cost and early functional results. Am J Sports Med 2004; 32: 197–200.

Harner CD, Olson E, Irrgang JJ, Silverstein S, Fu FH, Silberg M. Allograft versus autograft anterior cruciate ligament reconstruction. 3- to 5-year outcome. Clin Orthop 1996; 324: 134–44.

Lephart SM, Kocher MS, Harner CD, Fu FH. Quadriceps strength and functional capacity after anterior cruciate ligament reconstruction. Patellar tendon autograft versus allograft. Am J Sports Med 1993; 21: 738–43.

Stringham DR, Pelmas CJ, Burks RT, Newman AP, Marcus RL. Comparison of anterior cruciate ligament reconstruction using patellar tendon autograft or allograft. Arthroscopy 1996; 12: 414–21.

Asselmeier MA, Caspari RB, Bottenfield S. A review of allograft processing and sterilization techniques and their role in transmission of the human immunodeficiency virus. Am J Sports Med 1993; 21: 170–5.

Buck BE, Resnick L, Shah SM, Malinin T. Human immunodeficiency virus cultured from bone: Implications for transplantation. Clin Orthop 1990; 251: 249–53.

Roberts TS, Drez D Jr, McCarthy W, Paine R. Anterior cruciate ligament reconstruction using freeze-dried, ethylene oxide sterilized bone-patellar tendon-bone allografts. Two year results in 36 patients. Am J Sports Med 1991; 19: 35–41.

Jackson DW, Grood ES, Goldstein JD, Rosen MA, Kurzweil PR, Cummings JF, Simon TM. A comparison of patellar tendon autograft and allograft used for anterior cruciate ligament reconstruction in the goat model. Am J Sports Med 1993; 21: 176–85.

Zoltan DJ, Reinecke C, Indelicato PA. Synthetic and allograft anterior cruciate ligament reconstruction. Clin Sports Med 1988; 7: 773–84.

How to Cite
Sajovic M. One-stage bilateral anterior cruciate ligament reconstruction with use of hamstring tendon autografts: a case report. ZdravVestn [Internet]. 1 [cited 30Mar.2020];76. Available from:
Case report