Kinematic study following double-bundle, anterior cruciate ligament reconstruction

Abstract

The purpose of this study was to evaluate tibiofemoral kinematics after double-bundle anterior cruciate ligament (ACL) reconstructions and compare them with those of successful single-bundle reconstructions and contralateral normal knees using open MR images. We obtained MR images based on the flexion angle without weight-bearing, from 20 patients with successful unilateral single-bundle (10 patients) and double-bundle (10 patients) ACL reconstructions with tibialis anterior allografts and a minimum 1-year follow-up. The MR images of the contralateral uninjured knees were used as normal controls. Sagittal images of the mid-medial and mid-lateral sections of the tibiofemoral compartments were used to measure the translation of the femoral condyles relative to the tibia. The mean translations of the medial femoral condyles on the tibial plateaus during knee joint motion showed no significant differences among normal, single-bundle, and double-bundle ACL reconstructed knees (all p>0.05). The mean translations of the lateral femoral condyles showed a significant difference between normal and single-bundle reconstructed knees, or between single-bundle and doublebundle reconstructed knees (p<0.05). However, there was no significant difference between normal and doublebundle reconstructed knees (p=0.220). These findings suggest that double-bundle ACL reconstruction restores normal kinematic tibiofemoral motion better than singlebundle reconstruction.Résumé Le but de cette étude était d'évaluer, par les images de résonnance magnétique, la cinématique tibiofémorale après reconstruction du ligament croisé antérieur par double tunnel et de la comparer avec celle obtenue après réussite des reconstructions à un seul tunnel et celle du genou normal controlatéral. Nous avons étudié des images basées sur l'angle de flexion en décharge chez 20 patients après reconstruction par allogreffe tibiale antérieure suivis au moins un an : 10 avec succés de la reconstruction par un seul tunnel et 10 avec reconstruction par un double tunnel. Les images du genou controlatéral non traumatisé servaient de contrôle. Des images sagittales de la partie moyenne des compartiments fémoro-tibiaux permettaient la mesure de la translation des condyles fémoraux par rapport au tibia. La translation du condyle interne pendant la flexion du genou n'était pas différente entre le genou normal et la reconstruction par simple ou double tunnel (p>0,05). La translation du condyle externe était significativement différente entre le genou normal et la reconstruction par simple tunnel et entre les reconstructions par simple et double tunnel (p<0,05). Cependant il n'y avait pas de différence entre le genou normal et la reconstruction par double tunnel (p=0,220). Ces résultats suggèrent que la reconstruction du croisé antérieur par double tunnel restore mieux la cinématique du genou que la reconstruction par simple tunnel.

A prospective randomised study of anatomical single-bundle versus double-bundle anterior cruciate ligament reconstruction: quantitative evaluation using an electromagnetic measurement system

“…The goal of ACL reconstruction is to restore normal knee kinematics and to allow the patients to return to a previous level of function. Several biomechanical studies demonstrate that double-bundle ACL reconstruction improves anterior tibial translation and rotation [1,2,29]. Other reports support the integrity of this procedure, which was designed to reproduce the AMB and PLB, and it has theoretic advantages in controlling rotational torque proved by robotic study [3,4,7].…”

Effects of Anterolateral Structure Augmentation on the In Vivo Kinematics of Anterior Cruciate Ligament–Reconstructed Knees

“…8,28,44,67 The ACL, with the posterior cruciate ligament, helped maintain normal femoral rollback. Seon et al, 60 Takeda et al, 67 and Iriuchishima et al 28 successively reported restoration of near-normal femoral rollback with anatomic double-bundle ACLR as measured by radiographic imaging. Consistent with these results, we found no significant difference in the anteroposterior translation of contralateral controls and ACL-reconstructed knees with or without ALSA.…”

The Kinematic Basis of Anterior Cruciate Ligament Reconstruction

“…It has been proposed that a more anatomical ACL reconstruction will more effectively restore native ACL kinematics and dynamic knee function. Cadaveric and in vivo MRI studies evaluating knee kinematics after double bundle (DB) ACL reconstruction showed superior results compared to SB ACL reconstruction (43, 44). These results were confirmed by a recent meta-analysis, which showed that even in laxity tests like KT-1000 and pivot shift, DB ACL reconstruction achieved superior results in comparison to SB ACL reconstruction (45, 46).…”