Anatomic double-bundle and over-the-top single-bundle with additional extra-articular tenodesis: an in vivo quantitative assessment of knee laxity in two different ACL reconstructions

PurposeCombinations of intra- and extra-articular procedures have been proposed for anterior cruciate ligament reconstruction with the aim of achieving an optimal control of translational and rotational knee laxities. Recently, the need for better reproducing the structural and functional behavior of the native anterior cruciate ligament led to the definition of anatomic double-bundle surgical approach. This study aimed to quantitatively verify whether the in vivo static and dynamic behavior obtained using over-the-top single-bundle with extra-articular tenodesis reconstruction was comparable to the results achieved by anatomic double-bundle approach.MethodsThirty-five consecutive patients, with an isolated anterior cruciate ligament injury, were included in the study. Standard clinical laxities and pivot-shift test were quantified before and after anterior cruciate ligament reconstruction by means of a surgical navigation system dedicated to kinematic assessment; displacements of medial and lateral compartment during stress tests were also analyzed.ResultsSingle-bundle with extra-articular tenodesis approach presented statistically better laxity reduction in varus/valgus stress test at full extension and in internal/external rotation at 90° of flexion; lateral plasty controlled better the lateral compartment during drawer test and varus/valgus stress test both at 0° and 30° of flexion and both the compartments during internal/external rotation at 90° of flexion. On the other hand, pivot-shift phenomenon was better controlled by anatomic double-bundle reconstruction.ConclusionsBoth the reconstructions worked similarly for static knee laxity. The extra-articular procedure played an important role in better constraining the displacement of lateral tibial compartment, whereas the anatomic double-bundle reconstruction better restored the dynamic behavior of knee joint highlighted under pivot-shift stress test.Study designCase series.

[1]  Eun Kyoo Song,et al.  Prospective Comparative Study of Anterior Cruciate Ligament Reconstruction Using the Double-Bundle and Single-Bundle Techniques , 2009, The American journal of sports medicine.

[2]  J. Sekiya.  Double-Bundle Versus Single-Bundle ACL Reconstruction , 2012 .

[3]  James R. Robinson,et al.  Computer-assisted, anatomic, double-bundle anterior cruciate ligament reconstruction. , 2008, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[4]  Freddie H. Fu,et al.  The Kinematic Basis of Anterior Cruciate Ligament Reconstruction , 2008 .

[5]  J. Nyland,et al.  Anatomic double bundle ACL reconstruction: a literature review , 2007, Knee Surgery, Sports Traumatology, Arthroscopy.

[6]  Jae-Hwa Kim,et al.  Double-Bundle Anterior Cruciate Ligament Reconstruction , 2011 .

[7]  Andrew D Pearle,et al.  Single-Bundle Anterior Cruciate Ligament Reconstruction , 2009, The American journal of sports medicine.

[8]  Stefano Zaffagnini,et al.  Computer-assisted anterior cruciate ligament reconstruction: an evidence-based approach of the first 15 years. , 2010, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[9]  Kouki Nagamune,et al.  Intraoperative Measurement of Pivot Shift by Electromagnetic Sensors , 2008 .

[10]  William I. Sterett,et al.  Relationships between Objective Assessment of Ligament Stability and Subjective Assessment of Symptoms and Function after Anterior Cruciate Ligament Reconstruction , 2004, The American journal of sports medicine.

[11]  Stefano Zaffagnini,et al.  Pivot‐shift test: Analysis and quantification of knee laxity parameters using a navigation system , 2009, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[12]  Eugene Kim,et al.  Outcome of arthroscopic single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: a preliminary 2-year prospective study. , 2010, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[13]  Yon-Sik Yoo,et al.  Changes in ACL length at different knee flexion angles: an in vivo biomechanical study , 2010, Knee Surgery, Sports Traumatology, Arthroscopy.

[14]  M. Marcacci,et al.  Anterior Cruciate Ligament Reconstruction Associated with Extra-articular Tenodesis , 2009, The American journal of sports medicine.

[15]  Stefano Zaffagnini,et al.  Anatomic double-bundle anterior cruciate ligament reconstruction with hamstrings. , 2003, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[16]  K. Markolf,et al.  Simulated pivot-shift testing with single and double-bundle anterior cruciate ligament reconstructions. , 2008, The Journal of bone and joint surgery. American volume.

[17]  Y. Ishibashi,et al.  Single- Versus Double-Bundle Anterior Cruciate Ligament Reconstruction Results Using Navigation: The Japanese Experience , 2008 .

[18]  Stefano Zaffagnini,et al.  Does a lateral plasty control coupled translation during antero-posterior stress in single-bundle ACL reconstruction? An in vivo study , 2008, Knee Surgery, Sports Traumatology, Arthroscopy.

[19]  A. De Carli,et al.  Double bundle or single bundle plus extraarticular tenodesis in ACL reconstruction? , 2007, Knee Surgery, Sports Traumatology, Arthroscopy.

[20]  Stefano Zaffagnini,et al.  Validation of a new protocol for navigated intraoperative assessment of knee kinematics , 2007, Comput. Biol. Medicine.

[21]  Clifford Goodman,et al.  American Society of Mechanical Engineers , 1988 .

[22]  R P Jakob,et al.  Grading the pivot shift. Objective tests with implications for treatment. , 1987, The Journal of bone and joint surgery. British volume.

[23]  M. Marcacci,et al.  Arthroscopic intra- and extra-articular anterior cruciate ligament reconstruction with gracilis and semitendinosus tendons , 1998, Knee Surgery, Sports Traumatology, Arthroscopy.

[24]  Xavier Tomas,et al.  Double-bundle versus single-bundle ACL reconstruction using the horizontal femoral position: a prospective, randomized study , 2009, Knee Surgery, Sports Traumatology, Arthroscopy.

[25]  S Martelli,et al.  KIN-Nav navigation system for kinematic assessment in anterior cruciate ligament reconstruction: Features, use, and perspectives , 2007, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[26]  F. Fu,et al.  Review Article: Anatomic Double Bundle Anterior Cruciate Ligament Reconstruction , 2007, Journal of orthopaedic surgery.

[27]  Freddie H. Fu,et al.  The Kinematic Basis of ACL Reconstruction. , 2008, Operative techniques in sports medicine.

[28]  G. Vairo,et al.  Premature knee osteoarthritis after anterior cruciate ligament reconstruction dependent on autograft. , 2010, Journal of sport rehabilitation.

[29]  P. Christel,et al.  [Anterior cruciate ligament reconstruction: biomechanical comparison on cadaver specimens using a single or double hamstring technique]. , 2004, Revue de chirurgie orthopedique et reparatrice de l'appareil moteur.

[30]  Stefano Zaffagnini,et al.  Reliability of a navigation system for intra-operative evaluation of antero-posterior knee joint laxity , 2009, Comput. Biol. Medicine.

[31]  Freddie H. Fu,et al.  Anatomic Double-bundle ACL Reconstruction , 2010, Sports medicine and arthroscopy review.