Double-bundle versus single-bundle ACL reconstruction using the horizontal femoral position: a prospective, randomized study

Abstract

The aim of this study was to evaluate whether anterior cruciate ligament (ACL) reconstruction using the double bundle technique (DB) improves stability in the knee compared with the single bundle technique (SB) with the femoral tunnel in a more horizontal position (2 or 10 o'clock). We conducted a randomized, prospective study. Forty patients were randomized to the DB group (20 patients) and the SB group (20 patients). Four-stranded semitendinosus and gracilis autologous grafts were used in the SB group and in the DB group the conventional four tunnel technique was carried out using the same tendons. The IKDC complete form was used for the preoperative evaluation, and in the follow-up the IKDC subjective knee evaluation form, IKDC current health assessment form and IKDC knee examination form were used. Anteroposterior (AP) laxity was evaluated by standardised and forced radiology in all patients. No significant preoperative between-group differences were found. During the follow-up, no differences were found between groups, except for significant between-group differences (P < 0.05) between the preoperative and postoperative evaluations. The IKDC index also showed significant differences in the 2-year follow-up. Median scores increased from 48 (range 41-54) to 81 (range 75-87) (P = 0.01) in the SB group and from 52 (range 46-58) to 80 (range 72-88) (P = 0.02) in the DB group. There were no significant differences between the groups in terms of functional scores. In conclusion, the 2 and 10 o'clock placements showed no significant differences between SB and DB techniques in the pivot-shift test, manual and radiological anterior posterior laxity and IKDC scores. However, significant between-group differences were found between the preoperative and postoperative evaluations.

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

“…Their main finding was that contrary to their hypothesis there was no significant difference between the SB and the DB group regarding stability or knee evaluation forms. Sastre et al [43] had similar results in their study at the two-year followup. Aglietti et al [44] reported two-year results in 2010.…”

Quantitative topographic anatomy of the femoral ACL footprint: a micro-CT analysis

“…The 'double bundle debate' [40,43] has opened the door to a greater understanding of native anatomy, and newer techniques have been investigated to improve the outcome following ACL reconstruction [25,46]. The evolution of anatomic ACL reconstruction has focused on changing the femoral tunnel position from the traditional high '11 o'clock' notch position [32] to the more anatomic mid-bundle position within the ACL footprint [19].…”

Technique of anatomical single bundle ACL reconstruction with rounded rectangle femoral dilator

“…Therefore, our rationale for developing the rounded rectangle dilators was the ability of the rounded rectangle tunnels to more closely mimic the femoral footprint (compared to the rounded tunnels). In addition, Ho et al [18] and Sastre et al [10] have reported that anatomical single bundle ACL reconstruction and double bundle ACL reconstruction provide very similar stability. Thus, attention has returned to single bundle reconstruction with the graft placed at the center of the anatomical position.…”

“…Several recent biomechanical studies have shown that single bundle ACL grafts that are placed in the center of their anatomic insertions can provide nearly normal knee kinematics, which are comparable to double bundle ACL reconstruction [10] . In 2010, we began performing anatomical single bundle ACL reconstruction with a navigation system, and have successfully restored good knee stability for most of our patients.…”