Anatomic Double-Bundle and Single-Bundle Reconstructions Yield Similar Outcomes Following Anterior Cruciate Ligament Rupture: A Systematic Review and Meta-analysis

Xu, Zhiteng; Ma, Liang; Li, Renbin

doi:10.1016/j.arthro.2023.05.017

Cited by 6 publications

(2 citation statements)

References 62 publications

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“…However, a statistically significant difference could not be shown in subjective evaluation. Xu et al have reported similar results in their new meta-analysis [ 28 ] which includes only anatomical ACL reconstructions. However, Eliya et al found that anatomical DB ACL reconstruction moderately improved Tegner scores over the long term [ 29 ].…”

Section: Discussionmentioning

confidence: 64%

Double-bundle anterior cruciate ligament reconstruction resulted in better International Knee Documentation Committee objective grading at fifteen year follow-up compared to single-bundle reconstruction

Seppänen,

Suomalainen,

Kiekara

et al. 2024

International Orthopaedics (SICOT)

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Purpose The aim of this prospective randomized study was to evaluate whether the use of the anatomic double-bundle (DB) method for anterior cruciate ligament (ACL) reconstruction results in better clinical outcomes and a lower incidence of graft failure compared with the anatomic single-bundle (SB) method. The hypothesis was that DB ACL reconstruction would result in a lower incidence of graft failure. Methods Patients were randomly assigned to either the SB group (n = 78) or the DB group (n = 75). Evaluation included clinical testing, subjective assessments, functional testing, and International Knee Documentation Committee (IKDC) objective grading. Surgical techniques were anatomic, and the rehabilitation protocol was standardized. Results At 15-year follow-up, information was available on 100 patients (65%), of whom 55 (36%) were accepted in the final statistical analysis. There were almost three times as many graft failures in the SB group, but the result wasn´t statistically significant. Subjective assessments, knee stability (KT -1000 and pivot shift), range of motion (ROM), and functional one leg hop test showed no statistically significant differences between the groups. However, DB ACL reconstruction resulted in better International Knee Documentation Committee objective grading (P < 0.001). Conclusion At the 15-year follow-up, double-bundle surgery resulted in significantly better International Knee Documentation Committee objective grading compared to single-bundle surgery.

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Section: Discussionmentioning

confidence: 64%

Double-bundle anterior cruciate ligament reconstruction resulted in better International Knee Documentation Committee objective grading at fifteen year follow-up compared to single-bundle reconstruction

Seppänen,

Suomalainen,

Kiekara

et al. 2024

International Orthopaedics (SICOT)

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“…The anterior cruciate ligament (ACL) is one of the most frequently injured ligaments [ 1 , 2 ] and ACL reconstruction (ACLR) is one of the three most commonly performed surgeries in orthopedics, and different techniques are used for this [ 3 , 4 , 5 , 6 ]. In Germany, the annual incidence of an ACL injury amounts to 40–50 cases per 100,000 citizens [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Wrap It! Preventive Antimicrobial Treatment Shows No Negative Effects on Tenocytes and Tendons—A Comprehensive Approach

Thierbach

Müller

Stange

et al. 2023

JCM

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Although the rate of infection after the reconstruction of a ruptured anterior cruciate ligament (ACL) is low, prophylactic incubation of the graft with vancomycin (Vanco-wrap or vancomycin soaking) is routinely performed. A cytotoxic effect of vancomycin is reported for several cell types, and the prophylactic treatment might prevent infection but harm the tissue and cells. Aim: A comprehensive study was performed to investigate the effect of vancomycin on tendon tissue and isolated tenocytes using cell viability, molecular and mechanical analysis. Material and methods: Rat tendons or isolated tenocytes were incubated in increasing concentrations of vancomycin (0–10 mg/mL) for different times, and cell viability, gene expression, histology and Young’s modulus were analyzed. Results: The clinically used concentration of vancomycin (5 mg/mL for 20 min) had no negative effect on cell viability in the tendons or the isolated tenocytes, while incubation with the toxic control significantly reduced cell viability. Increasing the concentration and prolonging the incubation time had no negative effect on the cells. The expression of Col1a1, Col3a1 and the tenocyte markers mohawk, scleraxis and tenomodulin was not affected by the various vancomycin concentrations. The structural integrity as measured through histological and mechanical testing was not compromised. Conclusion: The results proved the safe application of the Vanco-wrap on tendon tissue. Level of evidence: IV.

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Age under 20 years, pre‐operative participation in pivoting sports, and steep posterior tibial slope of more than 12° are risk factors for graft failure after double‐bundle anterior cruciate ligament reconstruction

Goto,

Honda,

Iwaso

et al. 2024

J. exp. orthop.

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PurposeYounger age and steep posterior tibial slope (PTS) have been reported as risk factors for graft failure after anterior cruciate ligament reconstruction (ACLR). Few studies have evaluated these risk factors simultaneously in a large cohort of patients undergoing double‐bundle ACLR (DB‐ACLR). Therefore, this retrospective study aimed to simultaneously investigate known risk factors such as PTS and age in DB‐ACLR, determine their thresholds and calculate odds ratios (ORs).MethodsWe investigated 482 knees that underwent DB‐ACLR with a follow‐up period of at least 2 years. Receiver operating characteristic analysis determined cut‐off values for age and PTS for graft failure. Subsequently, logistic regression analysis was conducted to evaluate the effects of age, sex, height, weight, laterality, surgical waiting period, pre‐operative sport type and level, meniscal injury, hyperextension, general joint laxity and PTS on graft failure.ResultsGraft failure was observed in 33 out of 482 knees (6.8%). Notably, the graft failure group was significantly younger (18.0 ± 5.0 years [standard deviation] vs. 30.4 ± 13.1 years, p < 0.01) and had a steeper PTS (11.9 ± 2.3° [standard deviation] vs. 9.6 ± 2.9°, p < 0.01) than the group with no graft failure. The cut‐off values were 20.0 years for age (specificity, 64.6%; sensitivity, 87.9% and area under the curve, 0.808) and 12.0° for PTS (specificity, 70.9%; sensitivity, 69.7% and area under the curve, 0.734). Logistic regression analysis identified an age of <20 years (OR = 10.1; p < 0.01), PTS of ≥12° (OR = 5.6; p < 0.01) and pre‐operative participation in pivoting sports (OR = 6.0; p < 0.01) as significant risk factors for graft failure.ConclusionWe identified an age of <20 years, PTS of ≥12° and pre‐operative participation in pivoting sports as significant risk factors for graft failure after DB‐ACLR.Level of EvidenceLevel III.

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Anatomic Double-Bundle and Single-Bundle Reconstructions Yield Similar Outcomes Following Anterior Cruciate Ligament Rupture: A Systematic Review and Meta-analysis

Cited by 6 publications

References 62 publications

Double-bundle anterior cruciate ligament reconstruction resulted in better International Knee Documentation Committee objective grading at fifteen year follow-up compared to single-bundle reconstruction

Double-bundle anterior cruciate ligament reconstruction resulted in better International Knee Documentation Committee objective grading at fifteen year follow-up compared to single-bundle reconstruction

Wrap It! Preventive Antimicrobial Treatment Shows No Negative Effects on Tenocytes and Tendons—A Comprehensive Approach

Age under 20 years, pre‐operative participation in pivoting sports, and steep posterior tibial slope of more than 12° are risk factors for graft failure after double‐bundle anterior cruciate ligament reconstruction

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