Double-bundle anterior cruciate ligament reconstruction with split Achilles allograft and single tibia tunnel for small ACL tibial footprint : technical note with clinical results

Chae, In Jung; Bae, Ji Hoon; Wang, Joon Ho; Jeon, Ju-Hyun; Park, Jong Hoon

doi:10.1007/s00402-013-1734-5

Cited by 6 publications

(7 citation statements)

References 37 publications

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“…At present, the techniques for double-bundle reconstruction of the ACL described in the literature vary greatly based on tunnel locations. Some favour drilling one tibial tunnel for both the AM and PL bundles and two femoral tunnels [10] , [11] , [12] , [13] , [14] . Others are inclined towards drilling both two tibial and femoral tunnels for AM and PL bundles [15] , [16] , [17] .…”

Section: Discussionmentioning

confidence: 99%

Comparison of anterior cruciate ligament reconstruction methods between reverse “Y” plasty reconstruction and traditional single-bundle technique—A cadaveric study

Song

et al. 2018

Journal of Orthopaedic Translation

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SummaryBackgroundIn 2009, a reverse “Y” plasty anterior cruciate ligament (ACL) reconstruction technique was proposed, with double-tibial tunnel and single-femoral tunnel, and the result obtained proved that the reverse “Y” plasty technique was satisfactory. This cadaveric study was designed to compare the reverse “Y” plasty reconstruction method with the conventional single-bundle technique for the first time.MethodsIn this study, 30 cadaveric knees were used and were randomly divided into five groups with six knees each. Six cadaveric knees with intact ACL were treated as the control group, and another six knees with ruptured ACL were treated as the rupture group. In group A, the single-bundle technique was used. In groups B and C, reverse “Y” plasty technique was used, and the grafts were fixed with absorbable biointerference screws in tibiae and absorbable biointerference screws (Group B) or Endobutton (Group C) in femora. Five groups were tested with an MTS material testing machine (MTS-858) by the use of a cyclic loading of 134 N at 15°, 30°, 60° and 90° of knee flexion and a combined 7-Nm valgus torque and 5-Nm internal tibial rotation torque at 15°, 30°, 45° and 60° of knee flexion.ResultsBoth single-bundle and reverse “Y” plasty groups demonstrated similar anterior–posterior stability compared with the control group, whereas the single-bundle group showed inferior rotational stability tested at 30° and 45° of knee flexion than the reverse “Y” plasty group and control group. These two different fixation methods at the femoral site (Group B and C) showed no difference in anterior–posterior and rotational stability.ConclusionsThe new reverse “Y” plasty ACL reconstruction method may restore normal knee stability, especially rotational stability, better than single-bundle reconstruction.The translational potential of this articleThis study provides strong support for the new reverse “Y” plasty ACL reconstruction technique and is expected to propose a new surgical approach with good biomechanical features.

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Section: Discussionmentioning

confidence: 99%

Comparison of anterior cruciate ligament reconstruction methods between reverse “Y” plasty reconstruction and traditional single-bundle technique—A cadaveric study

Song

et al. 2018

Journal of Orthopaedic Translation

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“…A number of biomechanical [6,14,29,36] and clinical studies [1,4,17,18,22,23,26,37,39] with different techniques have been published. Improved results were reported for the double-bundle reconstruction with one tibial tunnel compared to a single-bundle reconstruction, particularly for the simulated pivot shift, but also in anterior tibial translation [6,23,36].…”

Section: Introductionmentioning

confidence: 99%

“…Particularly in cases with small tibial insertion sites, the possibility of reconstructing the ACL by a double‐bundle technique may be restricted to a reconstruction with only one tibial tunnel. A number of biomechanical [6, 14, 29, 36] and clinical studies [1, 4, 17, 18, 22, 23, 26, 37, 39] with different techniques have been published. Improved results were reported for the double‐bundle reconstruction with one tibial tunnel compared to a single‐bundle reconstruction, particularly for the simulated pivot shift, but also in anterior tibial translation [6, 23, 36].…”

Section: Introductionmentioning

confidence: 99%

“…Although several technical descriptions of ACL double‐bundle reconstructions with three tunnels were published previously [1, 4, 6, 14, 17, 18, 22, 23, 26, 29, 36, 37, 39], there remains a lack of biomechanical data, especially with a focus on the tension of the grafts under anterior shear forces. When considering the individual anatomy of each patient, this double‐bundle technique could provide an additional useful option.…”

Section: Introductionmentioning

confidence: 99%

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ACL double-bundle reconstruction with one tibial tunnel provides equal stability compared to two tibial tunnels

Drews

Seitz

Huth

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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Tightening both bundles in ACL double-bundle reconstruction with one or two tibial tunnels in different flexion angles achieved comparable restoration of stability, although there was different load sharing on the bundles. With regard to individualized ACL reconstruction, the double-bundle technique with one tibial tunnel offers a possibility to address small tibial insertion sites without compromising the advantages of a double-bundle procedure.

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“…Furthermore, the study defined the size of reaming diameter at 8 mm for AM and 6 mm for PL tunnel, however, surgeons clinically can select different reaming diameter case by case. Some studies suggest that 6 or 7 mm graft thickness is most appropriate for AM bundle, 13 , 21 , 22 however, we standardized 8 mm tunnel for AM bundle in this experimental cadaveric study because basic science is the foundation for the clinical research and ultimately treatment strategies and also we tried to occupy as much native footprint of AM bundle as possible by graft. The present in vitro cadaveric basic science study is more standardized than the clinical research.…”

Section: Discussionmentioning

confidence: 99%

Correlation between Femoral Guidewire Position and Tunnel Communication in Double Bundle Anterior Cruciate Ligament Reconstruction

et al. 2014

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PurposeThe object of this study was to determine the shortest possible distances of antero-medial (AM) and postero-lateral (PL) guide wire tunnel positions required to prevent femoral bone tunnel communication in double-bundle anterior cruciate ligament (ACL) reconstruction using human cadaver knees.Materials and MethodsThe centers of femoral AM and PL bundles of 16 cadaveric knees were drilled with guide wires and the distances of guide wires, were measured upon entrance into the bone. Femoral tunnel drilling was performed using transportal technique. The diameters of AM and PL graft were 8 mm and 6 mm, respectively. CT scans were taken on each knee, and 3-dimensional models were constructed to identify the femoral tunnel position and to create AM and PL tunnel virtual cylinders. Thickness of the bone bridge between the two tunnels was measured.ResultsIn four out of six specimens, in which the guide wires were placed at less than or equal to 9 mm, communication was noted. In specimens with guide wires placed at distances greater than or equal to 10 mm, communication was not noted. The two groups showed a statistically significant difference (p=0.008). In cases where the distance between the AM and PL femoral tunnel guide wires was 12 mm, the bone bridge thickness was greater than 2 mm along the tunnel.ConclusionThe technique for double bundle-anterior cruciate ligament (DB-ACL) reconstruction that we show here can avoid bone tunnel communication when AM and PL femoral guide wires are placed at least 10 mm apart, and 12 mm should be kept to preserve 2 mm bone bridge thickness.

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Double-bundle anterior cruciate ligament reconstruction with split Achilles allograft and single tibia tunnel for small ACL tibial footprint : technical note with clinical results

Abstract: Level IV, therapeutic study.

Cited by 6 publications

References 37 publications

Comparison of anterior cruciate ligament reconstruction methods between reverse “Y” plasty reconstruction and traditional single-bundle technique—A cadaveric study

Comparison of anterior cruciate ligament reconstruction methods between reverse “Y” plasty reconstruction and traditional single-bundle technique—A cadaveric study

ACL double-bundle reconstruction with one tibial tunnel provides equal stability compared to two tibial tunnels

Correlation between Femoral Guidewire Position and Tunnel Communication in Double Bundle Anterior Cruciate Ligament Reconstruction

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