[Comparative study of anterior cruciate ligament reconstruction between the One Band and U-Two techniques] (original) (raw)
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Anatomical reconstruction of anterior cruciate ligament of the knee: double band or single band?
2012
Objective: To evaluate the double-band and single-band techniques for anatomical reconstruction of the anterior cruciate ligament of the knee and demonstrate that the doubleband technique not only provides greater anterior stability but also causes less pain and a better subjective patient response. Methods: We selected 42 patients who underwent anterior cruciate ligament reconstruction, by means of either the single-band anatomical reconstruction technique, using flexor tendon grafts with two tunnels, or the double-band anatomical reconstruction technique, using four tunnels and grafts from the semitendinosus and gracilis tendons. All fixations were performed using interference screws. There was no variation in the sample. Before the operation, the objective
Arthroscopy-the Journal of Arthroscopic and Related Surgery, 2010
Purpose: The objective of this study was to analyze 2 different single-bundle anterior cruciate ligament (ACL) reconstruction procedures and compare their ability to reduce the pivot-shift phenomenon with an anatomic double-bundle (DB) technique. Methods: Twelve fresh-frozen cadaveric hip-to-toe lower extremity specimens were used. ACL reconstructions were performed by conventional single-bundle, anteromedial (AM) single-bundle, and DB techniques. Anterior tibial translation was measured in the intact knee, ACL-deficient knee, and the 3 ACL reconstructions in response to a Lachman test and a mechanized pivot-shift test. A surgical navigation system (Praxim Medivision, Grenoble, France) simultaneously tracked kinematics. Results: Intact knees were clinically graded as grade 0 (n ϭ 12). ACL-deficient knees were graded as grade 1 (n ϭ 10) and grade 2 (n ϭ 2). With a mechanized pivot-shift test, anterior tibial translation was 1.7 Ϯ 3.0 mm, 9.7 Ϯ 3.8 mm, 4.4 Ϯ 1.0 mm, 1.8 Ϯ 1.5 mm, and Ϫ1.7 Ϯ 3.3 mm for intact knees, ACL-deficient knees, conventional technique, AM technique, and DB technique, respectively. There was a significant difference between the DB technique and both single-bundle techniques tested (P Ͻ .05). Conclusions: The model used represents an isolated ACL injury without concomitant injury to the capsuloligamentous restraints or menisci. However, during the pivot shift, neither type of singlebundle ACL reconstruction stabilized the knee to the same degree as the DB ACL reconstruction. Clinical Relevance: In this cadaveric model a DB repair offers great anterior and rotational stability. Although this study suggests that the DB technique is biomechanically superior to a single-bundle technique using traditional transtibial tunnel positions, there appear to be minimal differences in knee kinematics during stability testing with the DB technique versus an AM graft position. Indeed, compared with the AM position alone, the DB technique "overconstrained" the kinematics of the knee during a pivoting maneuver at time zero in a cadaveric model with an isolated ACL injury.
Stability comparison of anterior cruciate ligament between double- and single-bundle reconstructions
International Orthopaedics, 2009
The purpose of this study was to evaluate the intra-operative stability during double-bundle anterior cruciate ligament (ACL) reconstructions (20 knees) using a navigation system and compare the results with those obtained from single-bundle reconstructions (20 knees). After registering the reference points during ACL reconstruction, antero-posterior and rotational stability tests with 30°knee flexion using a navigation system were measured before and after reconstructions on both groups. The change of antero-posterior translation after and before reconstruction was 12.5 mm in the double-bundle group and 10.5 mm in the single-bundle group, showing significant inter-group difference (p=0.014, from 17.5 mm to 5.1 mm in the double-bundle and from 16.6 mm to 6.1 mm in the single-bundle group). The mean rotational stability of the double-bundle group also showed more significant improvement after reconstruction compared to that of the single-bundle group (9.8°in the double-and 5.6°in the single-bundle groups, p<0.001). These findings suggest that a double-bundle ACL reconstruction restores greater knee stability with respect to the antero-posterior and rotational stability than a single-bundle reconstruction.
Anterior cruciate ligament repair versus reconstruction: A kinematic analysis
2019
Background: The purpose of this study was to compare the biomechanical properties of an anterior cruciate ligament (ACL) anatomic repair of a true femoral avulsion to an anatomic ACL reconstruction. It was hypothesized that the ACL repair and ACL reconstruction would have comparable biomechanical behavior when compared to the native knee. Methods: Ten paired fresh-frozen cadaveric knees (n = 20) were used to investigate knee kinematics when an anterior drawer force, varus, valgus, internal, and external rotational moment were applied at 0, 15, 30, 45, 60, and 90 degrees of flexion. Displacement and rotation were recorded in the following conditions: ACL-intact, ACL-deficient, and ACL-repaired vs reconstructed. Results: Sectioning of the ACL significantly increased anterior tibial translation (0°, 15°, 30° and 45°) compared to the intact state. The mean anterior displacement difference from intact was lower in the ACL-repaired knees compared to reconstructed knees at 30° and 90°. There were no significant differences between conditions in varus, valgus, internal, or external rotations. Conclusion: ACL repair and ACL reconstruction procedures restored knee anterior tibial translation in matched paired specimens. There were no differences in valgus, varus, internal, or external rotation. Although, ACL-repaired knees (avulsion model) demonstrated less anterior tibial translation when compared to ACL-reconstructed knees, this difference was less than one millimeter. Based on the findings of this study, repair and reconstruction procedures both restored anterior tibial translation in matched-pair specimens. This suggests that the initial functionality of both techniques is similar and that further clinical studies are needed to compare the long-term stability.
Indian Journal of Orthopaedics, 2015
Background: Single bundle anterior cruciate ligament (ACL) reconstruction has been the current standard of treatment for ACL defi ciency. However, a signifi cant subset of patients continue to report residual symptoms of instability with a poor pivot control. Cadaveric biomechanical studies have shown double bundle (DB) ACL reconstructions to restore the knee kinematics better. This study evaluates the outcome of DB ACL reconstruction. Materials and Methods: 30 consecutive patients who underwent anatomic DB ACL reconstruction were included in this prospective longitudinal study. There were all males with a mean age of 25 ± 7.45 years. All patients were prospectively evaluated using GeNouRoB (GNRB) arthrometer, functional knee scores (International Knee Documentation Committee [IKDC] and Lysholm) and postoperative magnetic resonance imaging (MRI) for comparing the graft orientation and footprint of the reconstructed ACL with that of the normal knee. Results: The average followup was 36.2 months. At the time of fi nal followup the mean Lysholm score was 93.13 ± 3.31. As per the objective IKDC score, 26 patients (86.6%) were in Group A while 4 patients (13.3%) were in Group B. The mean differential anterior tibial translation by GNRB, arthrometer was 1.07 ± 0.8 mm (range 0.1-2.3 mm). All cases had a negative pivot shift test. MRI scans of operated and the contralateral normal knee showed the mean sagittal ACL tibial angle coronal ACL tibial angle and tibial ACL footprint to be in accordance with the values of the contralateral, normal knee. Conclusion: The study demonstrates that DB ACL reconstruction restores the ACL anatomically in terms of size and angle of orientation. However, long term studies are needed to further substantiate its role in decreasing the incidence of early osteoarthritic changes compared to the conventional single bundle reconstructions.
Knee Surgery, Sports Traumatology, Arthroscopy, 2014
during graft tensioning (124; 81 %) and placement of the tibial tunnel at the ACL insertion site (101; 66 %). The highest level of documentation used for ACL tunnel position for both groups was often one dimensional, e.g. drawing, operative notes or o'clock reference. The DB reconstruction was in general more thoroughly reported. The means for the AARSC were 6.9 ± 2.8 for the SB group and 8.3 ± 2.8 for the DB group. Both means were below a proposed required minimum score of 10 for anatomic ACL reconstruction. Conclusions There was substantial underreporting of surgical data for both the SB and DB groups in clinical studies. This underreporting creates difficulties when analysing, comparing and pooling results of scientific studies on this subject.
Single versus two-incision arthroscopic anterior cruciate ligament reconstruction
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 1996
The purpose of this study was to compare single (endoscopic) versus two-incision arthroscopic anterior cruciate ligament reconstruction using bonepatellar tendon-bone in a population of young athletes. All patients followed a similar postoperative rehabilitation program. The Lysholm knee score, the International Knee Documentation Committee Score, KT-1000 arthrometric measurements, Lachman tests, pivot shift tests, isokinetic and functional testing, and perioperative complications were used to compare the two techniques. Anteroposterior and lateral radiographs were also evaluated and compared. Group I comprised 51 patients who underwent two-incision arthroscopic ACL reconstruction. The average age was 19.8 years, with a range of 18 to 22. The average follow-up in this group was 31 months (range, 24 to 43 months). Group II, the endoscopic group, consisted of 31 patients with an average age of 19.4 years (range, 18 to 22). The average follow-up was 25 months (range, 24 to 31 months). There were no significant differences between the two groups using subjective, objective, and functional criteria. There did appear to be a trend toward a residual pivot glide in the endoscopic group, but this did not achieve statistical significance. Radiographic analysis demonstrated an increased incidence of screw divergence in the endoscopic group. Intraoperative complications were more common with the endoscopic method.