Table 3.

Advantages, Risks, and Limitations

Advantages

1.The ACL femoral footprint can be occupied by as many sutures as possible with this intra-articular double-bundle technique.

2.Different preparation methods for femoral AM and PL tunnel are used (AM tunnel, transportal drilling with a flexible reamer; PL tunnel, outside-in drilling with a rigid reamer), which creates a divergent trajectory of both tunnels, avoiding undesirable tunnel coalesce.

3.Lateral augmentation of the knee (anterolateral ligament reconstruction in the index technique) can be accomplished without harvesting the iliotibial band.

4.Isometric points of anterolateral ligament fixation are used (proximally and posteriorly to the lateral femoral epicondyle and just posteriorly and proximally to the Gerdy's tubercle).

5.Only 2 stabbing wounds are needed in the lateral knee. It is less invasive than the Lemaire procedure.

Risks

1.Chances of tunnel coalesce, although low, may still occur between femoral AM/PL tunnel, and tibia ACL/ALL tunnel.

2.Nonisometric tunnel creation may still occur, especially in oversized patients.

3.The femoral interference screw at the femoral PL tunnel may be too prominent to cause painful friction symptoms with the iliotibial band and should be checked before wound closure.

4.The gracilis tendon and FiberTape should pass beneath the iliotibial band; otherwise, it will cause lateral knee impingement and pain.

Limitations

1.The diameter of the triple-folded semitendinosus graft is normally <8 mm (7 to 8 mm). Therefore, another bundle of graft intra-articularly should be reconstructed (the PLB with single gracilis and FiberTape).

2.The diameter of the single-strand gracilis graft is normally <5 mm. However, if it is folded twice, the length of the prepared graft (as the PL bundle) may not be long enough to provide ≥25 mm inside the tibia ALL tunnel.

3.Therefore, a FiberTape from a 4.75-mm Swivelock anchor is used for augmentation with the single-strand gracilis tendon to provide initial stability and increase the diameter of the PL bundle.

4.The absolute indications are not wholly established yet.