Clinical outcome of transportal anatomical single bundle ACL reconstruction with hamstring graft: A prospective study

Introduction: Arthroscopic reconstruction is currently the definitive treatment for symptomatic instability of the Anterior Cruciate Ligament (ACL). Although surgical methodologies vary, achieving an anatomical femoral tunnel position is paramount for restoring rotational control. This prospective investigation aimed to assess the functional results of single-bundle anatomical ACL reconstruction utilizing a quadrupled hamstring tendon autograft via the transportal technique. Methods: We conducted a prospective analysis of 30 skeletally mature individuals (aged 20-40 years) presenting with symptomatic unilateral ACL deficiency over a 12-month duration. All participants underwent anatomical single-bundle reconstruction with a quadrupled hamstring autograft. To guarantee anatomical positioning, the femoral tunnel was created independently through an accessory anteromedial (transportal) portal. Functional recovery was evaluated at baseline and 12 months post-surgery using the Lysholm Knee Score and the International Knee Documentation Committee (IKDC) Subjective Score. Results: The cohort had a mean age of 29.50±9.67 years and was predominantly male (93.3%). Road Traffic Accidents were the primary injury mechanism (70.0%). At the one-year follow-up, the average Lysholm score rose to 90.47±7.48, with 80.0% of subjects categorized as having Good or Excellent outcomes. Similarly, the mean IKDC subjective score demonstrated a statistically significant increase from a pre-operative baseline of 50.61±9.13 to 87.31±6.41 (p = 0.001). Adverse events were rare, with 80% of the study population reporting no complications. Conclusion: The transportal anatomical single-bundle ACL reconstruction technique, employing a quadrupled hamstring autograft, delivers superior knee stability and functional improvement. This approach efficiently re-establishes native knee kinematics with minimal donor site morbidity, enabling active adults to resume their pre-injury lifestyles.