An In Vivo Biomechanical Study on the Tension–Versus–Knee Flexion Angle Curves of 2 Grafts in Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction: Effects of Initial Tension and Internal Tibial Rotation

Comparable Results Between Lateralized Single- and Double-bundle ACL Reconstructions

“…Therefore, the PLB graft of DBH fixed at 20°to 30°knee flexion applying a manual maximum tensile load might be overloaded when approaching full extension and cause loss of extension. Although some studies have been performed to determine the ideal combination of knee angles and initial graft tension at the fixation of AMB and PLB grafts [16,29,53], it has not been established. Because the graft tensioning might contribute to the remodeling process of the graft and to the long-term clinical results consequently, additional study is required.…”

Biomechanical Comparisons of Knee Stability After Anterior Cruciate Ligament Reconstruction Between 2 Clinically Available Transtibial Procedures

“…Our previous work had shown that this graft fixation protocol could restore the kinematics of an intact knee, 9 and this graft fixation method has been used clinically. 16,35,36 Finally, each double-spiked plate was fixed to the surface of the tibia with a cancellous bone screw.…”

“…Because the single-bundle reconstruction approximated the AM bundle, the graft was more vertical than the PL bundle of the ACL so it could not effectively stabilize knee rotation near the full extension position. Yasuda et al 35 measured the AM and PL graft tensions intraoperatively and found that tension of the PL graft was increased significantly by internal rotation at 15°and 30°of knee flexion. As the single-bundle reconstruction reproduced the AM bundle, these reconstructions did not stabilize the knee near extension in response to 5-NÁm internal rotation torque.…”

“…22,33,34 In vivo studies using position or force sensors have found that knee kinematics and graft functions similar to those obtained in the above-described cadaveric studies could be obtained in clinical arthroscopic procedures. 14,35 An arthroscopic second-look study 16 found that both the AM and PL bundles were reconstructed in 96% of 132 patients with the anatomic double-bundle ACL reconstruction. These in vitro and in vivo studies support the present results with superior knee stability after the anatomic double-bundle ACL reconstruction in comparison with the conventional single-bundle reconstruction.…”

ACL Stability, Function, and Arthritis: What Have We Been Missing?

“…The concept of double-bundle ACL reconstruction arises from biomechanical studies demonstrating the inability of some single-bundle techniques (reconstructing only the AM bundle) to fully restore knee stability [3][4][5][6] and longitudinal studies showing the development of osteoarthritis in patients who underwent single-bundle ACL reconstruction.…”