Background: The technique of arthroscopic anterior cruciate ligament reconstruction (ACLR) has undergone many modifications in the recent times with improved understanding of anatomy, kinematics, and biology of the graft. In this study, we evaluated the functional outcome following arthroscopic single bundle ACLR with tibial attachment preserving quadrupled hamstring autograft without implant on the tibial side.

Results: There is a statistically significant increase in both IKDC and Lysholm score from preoperative/pre injury to post-operative assessment at minimal 9 month follow up.

The mean pre injury Tegner score was 5.7 ± 1.194 and mean post injury Tegner score was 5.2 ± 1.055. The mean pre injury lysholm score was 97.9 ± 2.308 which at minimum 9 month follow-up was 88.3 ± 8.036. Out of 52 patients 37 of the patients (71.2%) were able to return to their pre injury activity including to recreational and to competitive sports. 5 patients (9.6%) had a drop of 1 level in Tegner activity level from there pre injury level of activity. 7 patients (13.5%) had a drop of 2 level in Tegner activity level from there pre injury level of activity. 2 patients (3.8%) had a drop of 3 level in Tegner activity level from there pre injury level of activity. 1 case reported a 4 level drop from pre injury levels

Conclusion: Arthroscopic single-bundle ACL reconstruction using 4 stranded hamstring autograft, anatomic femoral tunnel placement and preservation of hamstring graft tibial insertion gives excellent to good functional outcome. Tibial attachment preserving hamstring graft without a tibial implant is a simple, time saving and cost effective technique that provides a consistently satisfactory outcome.