Double-Bundle Anterior Cruciate Ligament Reconstruction: The Italian Experience (original) (raw)
Related papers
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.
Double-bundle reconstruction cannot restore intact knee kinematics in the ACL/LCL-deficient knee
Archives of Orthopaedic and Trauma Surgery, 2010
Introduction The aim of this study was to evaluate the eVect of single-bundle (SB) and anatomic double-bundle (DB) anterior cruciate ligament (ACL) reconstruction on the resulting knee kinematics in a simulated clinical setting with ACL rupture and associated extra-articular damage to the lateral structures. It was hypothesized that anatomic DB ACL reconstruction restores the intact knee kinematics in ACL/LCL-deWcient knees, whereas SB ACL reconstruction fails to restore the intact knee kinematics. Materials and methods Ten fresh-frozen human cadaver knees were subjected to anterior tibial load of 134 N (simulated KT 1000) and combined rotatory load of 10-Nm valgus and 4-Nm internal tibial torque (simulated pivot shift) using a robotic/UFS testing system. The resulting knee kinematics was determined for intact, ACL/LCL-deWcient, SB ACL-reconstructed/LCL-deWcient, and DB ACL-reconstructed/LCL-deWcient knee. Statistical analysis was performed using a two-way ANOVA test with the level of signiWcance set at P < 0.05. Results Under a simulated KT 1000 test, anterior tibial translation (ATT) following SB ACL reconstruction was statistically signiWcant at 0°, 30° and 60° of knee Xexion when compared to the intact knee. ATT after DB ACL reconstruction showed no statistically signiWcant diVerence from the intact knee; however, there was a signiWcant diVerence in SB reconstruction at 0° and 30° of knee Xexion. Under a simulated pivot shift test, both SB and DB ACL reconstruction failed to restore the intact knee kinematics. Conclusion The results of the study did not support our initial hypothesis. Though DB reconstructions were signiWcantly superior to SB reconstruction under simulated KT 1000 test, SB as well as DB reconstruction failed to restore the intact kinematics under simulated pivot shift loads. The clinical relevance of this study is that caution and precise preoperative diagnostics are needed to avoid failure of intra-articular ACL reconstruction if the extra-articular stabilizers are torn.
Functional outcome of double-bundle anterior cruciate ligament reconstruction
Formosan Journal of Musculoskeletal Disorders, 2012
Background/Purpose: The anterior cruciate ligament (ACL) is one of the most frequently injured ligaments in the knee joint and is generally treated by surgical reconstruction. A possible reason for the unsatisfactory nature of this reconstruction is that the complex function of the ACL is not reproduced by the traditional ACL reconstruction procedure, which replicates only a single bundle rather than the two separate bundles that form the original ACL. It has been suggested that re-establishment of the double-bundle anatomy of the ACL is crucial for obtaining a better restoration of the normal biomechanics of the knee and improving the knee's rotatory stability. The purpose of this study was to evaluate the authors' current double-bundle ACL reconstruction technique and assess the various functions of the anteromedial and posterolateral bundles. Methods: Patients were assessed for instability and laxity after a mean follow-up of 16 months (range, 12e26 months). The range of motion was measured and compared with the opposite normal knee. Clinical evaluation was performed using the modified Lysholm scoring scale, the Tegner activity scale, and the International Knee Documentation Committee (IKDC) rating system. Results: The study included 20 patients, 15 males and five females, with a mean age of 22.7 years (range, 18e29 years) at the time of surgery. Following the procedure described by Yasuda et al, double-bundle ACL reconstruction, which anatomically reproduces the anteromedial and posterolateral bundles using hamstring tendon grafts, was performed on patients under general anesthesia. The clinical results for the Lysholm rating system were good to excellent, being 71 points preoperatively and 94 postoperatively. The IKDC rating was 65% preoperatively and 92% postoperatively. All patients showed a negative pivot shifting test. Conclusion: The ACL not only is the primary restraint on anterior tibial translation but also contributes considerably to normal knee kinematics. Our study showed that the four-tunnel double-bundle ACL reconstruction provides significant advantages in terms of anterior and rotational stability as well as objective IKDC. The subjective measurement of postoperative functional results using either the Lysholm or the IKDC rating system revealed a promising outcome after a short follow-up period.
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.
Medical Engineering & Physics
Anterior cruciate ligament reconstruction techniques are evolving with innovations like double-bundle (DB) grafts and computer assistance. The current DB techniques do not appear to make the clinical difference yet. Insight in various techniques may lead to better results. In this study, the anterior laxity of a DB reconstruction with an anteromedial (AM) graft fixated in 90 • of flexion and a posterolateral (PL) graft fixated in 20 • and computer-assisted anatomically placed femoral attachments was compared to normal values and single-bundle grafts. In 8 fresh-frozen human cadaveric knees, the anterior laxity was tested from 0 • to 90 • flexion, with a 100 Newton (N) anterior tibial load in joints with (1) intact ACL, (2) torn ACL, (3) single-bundle (SB) graft tensed with 15 N in 20 • , (4) anatomic AM graft tensed with 15 N in 90 • , (5) anatomic PL graft tensed with 15 N in 20 • , and (6) anatomic DB graft (4 + 5).
Double-Bundle Anterior Cruciate Ligament Reconstruction
American Journal of Sports Medicine, 2009
Background: The anterior cruciate ligament-deficient (ACLD) knee requires appropriate treatment for the patient to return to sports. The purpose of this study was to clarify the kinematics of the anterior cruciate ligament-deficient knee in squatting motion before and after double-bundle anterior cruciate ligament reconstruction (DB-ACLR) using a 2D/3D registration technique. Methods: The subjects of this study were 10 men with confirmed unilateral ACL rupture who underwent DB-ACLR. Computed tomography (CT) of the knee joints was performed before DB-ACLR. Fluoroscopic imaging of the knee motion in squatting before and after DB-ACLR was also performed. The 2D/3D registration technique is a method of calculating positional relationships by projecting the 3D bone model created from the CT data onto the image extracted from the fluoroscopic images. The tibial anteroposterior (AP) and rotational positions were analyzed with reference to the femur. Results: The tibial AP position of the ACLD knees was significantly anterior to the contralateral knees (p = 0.015). The tibial rotational position of the ACLD knees was significantly internally rotated compared to the contralateral knees (p < 0.001). Both tibial AP and rotational positions improved after DB-ACLR (p < 0.001), with no significant differences compared to the contralateral knees. Conclusion: DB-ACLR improved not only tibial AP instability but also tibial rotational instability at knee flexion with weight-bearing. DB-ACLR appears to be a useful technique for normalizing the knee joint kinematics of ACLD knees.
International Orthopaedics, 2010
The study hypothesis was that the outcome of semitendinosus gracilis double bundle (STG-DB) anterior cruciate ligament (ACL) reconstruction is advantageous in terms of clinical results and restoration of anterior-posterior and rotational laxity in comparison to bone-patellar tendonbone single-bundle (PTB-SB) ACL reconstruction. We analysed 41 PTB-SB and 51 STG-DB patients using the Tegner, IKDC and WOMAC scores preoperatively and at a minimum follow-up of two years. At follow-up, there was no significant difference in the clinical scores. The KT 1000 side-to-side measurement showed no significant difference between groups. The STG-DB group was significantly superior in terms of the pivot-shift sign and anterior knee pain. We conclude that the outcome of STG-DB reconstruction in the mid-term was not advantageous in terms of clinical scores and anterior-posterior laxity evaluated by the KT 1000. Nevertheless, the restored rotational laxity measured by the pivot shift test was significantly superior in the STG-DB technique.