Functional double-bundle anterior cruciate ligament reconstruction using hamstring tendon autografts with preserved insertions is an effective treatment for tibiofemoral instability

Abstract

PurposeThe aim of this study was to introduce a modified anatomical anterior cruciate ligament reconstruction using functional double bundles (F‐DBACLR), which achieved sequential tensioning at all flexion angles postoperatively, and compare its clinical outcomes with the anatomical single‐bundle technique (A‐SBACLR). MethodsA total of 156 patients with an ACL injury underwent ACLR (A‐SB group, n = 78; F‐DB group, n = 78). All operations were performed by anatomically identifying the ACL footprints and fixing the graft at a pre‐determined degree of knee flexion. Two observers blinded to the patient identities examined the patients preoperatively and during follow‐up (median 28.2 months; range 26–31 months). Multiple subjective and objective clinical evaluation tests and assessment of clinical outcomes concerning the translational and rotational stability of the knee including the International Knee Documentation Committee (IKDC) questionnaire, Lysholm Knee Scoring Scale, Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Scale, KT‐1000 laxity measurements, Lachman test and pivot‐shift test were performed preoperatively and postoperatively. ResultsPreoperatively, no differences were found between the two groups. During the 2‐year observation period, patients in the F‐DB group revealed better clinical outcomes in terms of the Tegner Activity Scale Score, IKDC, KOOS and Lysholm Knee Scoring Scale. Similar results were shown in regard to the translational stability in both groups, while the F‐DB group had more rotational stability at 2 years of follow‐up. ConclusionsThe clinical outcomes indicated that F‐DBACLR is clinically practicable and advantageous in the treatment of the ACL‐deficient knee. Level of evidenceII.

No Difference in Outcome of Anterior Cruciate Ligament Reconstruction with “Bone–patellar Tendon-bone versus Semitendinosus-gracilis Graft with Preserved Insertion:” A Randomized Clinical Trial

“…Another examiner (AS) did the allocation using a sealed enveloped system. In BPTB, cohort graft fixation was done at both tibial and femoral side using soft silk screw (Smith and Nephew, USA) and in hamstring cohort graft fixation was done only on the femoral side using EndoButton (Smith and nephew, USA) keeping tibial insertion preserved (free end sutured to its insertion using Ethibond suture) 202122. Athletes of both the groups underwent the same rehabilitation protocol postoperatively for 6 months.…”

Maturation of Anterior Cruciate Ligament Graft—Possibilities of Surgical Enhancement: What Do We Know So Far?

“…Nonetheless, despite the significant difference in functional outcomes, no clinically significant difference regarding these scoring systems were found. Zhang et al compared the outcomes between a single-bundle ACL reconstruction with a free hamstring autograft and so-called functional double-bundle ACL reconstruction, which included preservation of the hamstring tibial insertion and independent fixation of semitendinosus and gracilis grafts at different tensions in the single tibial tunnel [25]. The functional outcomes including the Tegner Activity Scale, IKDC score, Knee Injury and Osteoarthritis Outcome score and Lysholm score of the functional double-bundle ACL reconstruction group were better than the outcomes of the control group.…”

Editorial Commentary: The Measurement of Knee Laxity: Instrumented Measurement and Stress Radiography for Anterior Cruciate Ligament Injuries

“…As a matter of fact, Daniel and colleagues 3,16 described the flexion angle in which the KT-1000 device was used as being either 20 of recent months, it has to be noted that most of the authors describe the usage of the KT-1000 device at knee flexion angles of 20 or do not provide information about it at all. [9][10][11][12]17,18 Kennedy and Fowler 14 described their development of a clinical stress machine to obtain lateral radiographs with a knee flexion angle of 90 . The usage of stress radiographs in the setting of ACL injuries (and not posterior cruciate ligament or postero-lateral corner injuries) is rather rarely described, but recent publications used flexion angles of 90 as well as 20 .…”