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Outrata et al. [5] derived necessary optimality conditions for those MPECs which can be treated by the implicit programming approach and proposed a solution method based on the bundle technique of nonsmooth optimization.
The analysis of the effect of femoral tunnel orientation on a double bundle technique provides a new input, although previous studies have analyzed this aspect in single bundle reconstructions, showing how important is this factor in surgical techniques.
This finding is important not only in our unusual and not completely anatomical double bundle technique, but could be even more important when two femoral tunnels are performed for the reconstruction.
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Double bundle techniques present many surgical variables and Petersen [ 7] has shown that a second tibial tunnel provides better pivot shift control compared to two femoral tunnel and one tibial tunnel ACL reconstruction.
Recently, we successfully performed arthroscopic PCL reconstruction using the tibial-inlay and double-bundle technique.
They demonstrated that under combined anterior, internal tibial and valgus torque, knee stability using a double-bundle technique was superior to a single-bundle reconstruction technique.
A combination the posterior tibial inlay and femoral double-bundle technique is thought to be an ideal method for PCL reconstruction.
In biomechanical cadaver studies, Pfaeffle et al. [66] achieved adequate stabilisation of the IM and restoration of normal load transfer using the flexor carpi radialis tendon in a double-bundle technique.
An anatomic double-bundle technique using two autologous double-stranded semitendinosus tendons was employed for a remnant-preserving ACL reconstruction by the behind-remnant approach (Muneta et al. 2015).
A combined graft of semitendinosus and gracilis tendons using a single-bundle technique, as employed in our case report, was described in 1986 [9]; this is currently one of the most common techniques for ACL reconstruction.
Methods: Fifty-eight patients who underwent anatomical reconstruction of the anterior cruciate ligament using an autologous flexor tendon graft by means of the double-bundle technique were evaluated in accordance with the IKDC 2000 protocol.
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