Anterior cruciate ligament reconstruction using autologous hamstring double bundle graft compared with single bundle procedures

Abstract

A total of 218 patients with unilateral anterior cruciate ligament deficiency were randomly assigned to one of four groups. In group A an anatomical double bundle anterior cruciate ligament reconstruction was performed; group B were treated by a single bundle using an Endobutton for femoral fixation; in group C by a single bundle using RigidFix cross pins for femoral fixation; and in group D by a single bundle using a bioabsorbable TransFix II screw for femoral fixation. For tibial fixation a bioabsorbable Intrafix interference screw was used for all the groups and the graft was fashioned from the semitendinosus and gracilis tendons in all patients. In all, 18 patients were lost to follow-up. The remaining 200 were subjected to a clinical evaluation, with assessment of the anterior drawer, Lachman's and the pivot-shift tests, and KT-1000 arthrometer measurement. They also completed the International Knee Documentation Committee, Lysholm knee and Tegner activity scores. At a mean of 29 months (25 to 38) follow-up there were no significant differences concerning time between injury and range of movement and Lysholm knee scores among the four groups. However, the double bundle method showed significantly better results for the pivot-shift test (p = 0.002). The KT 1000 measurements showed a mean difference between the reconstructed knee and the patients' normal knee of 1.4 mm in the double bundle group and 2.4 mm in the single bundle group; which was statistically significant. The Lachman and anterior drawer tests also showed superior results for the double bundle method. The International Knee Documentation Committee scale showed no significant difference among the groups (p < 0.001). On clinical evaluation the double bundle group showed less laxity than the single bundle groups. However, regardless of the technique, all knees were improved by anterior cruciate ligament reconstruction compared with their pre-operative status.

Arthroscopic ACL reconstruction using patellar bone tendon autograft and Rigidfix fixation - A midterm functional outcome

“…Lachman, and anterior drawer test results, were all statistically significant when compared with the preoperative examination. Our results are comparable with various other studies 23,24 . The Lysholm score and the Tegner activity scales are the measures of health-related quality of life and patient satisfaction which has direct positive correlation with early return to activities 25 .…”

Anatomic Anterior Cruciate Ligament Reconstruction Utilizing the Double-Bundle Technique

“…38 Since the meta-analysis by Meredick et al, 55 there have been 6 additional randomized clinical trials comparing double-bundle ACL reconstruction to single-bundle ACL reconstruction. 3,35,70,74,83,90 Three of the trials 3,35,70 demonstrated that double-bundle ACL reconstruction resulted in significantly better side-to-side differences in anterior translation and a significantly higher proportion of normal pivot shift tests. To date, however, none of the studies have demonstrated that double-bundle ACL reconstruction results in better patient-reported outcomes.…”

Double-bundle Anterior Cruciate Ligament reconstruction: a review of literature

“…Ibrahim et al [41] had altogether 200 patients in their study, in which there were 50 patients in the DB group, 48 patients in the SB group with Endobutton fixation, 52 patients in the SB group with RigidFix fixation and 50 patients in the SB group with bioabsorbable Transfix II fixation. Follow-up time was 25-38 months (mean 29 months).…”