Single-Tunnel Double-Bundle Anterior Cruciate Ligament Reconstruction with Anatomical Placement of Hamstring Tendon Graft

Abstract

Background Anatomical reconstruction techniques that can restore normal joint kinematics without increasing surgical complications could potentially improve clinical outcomes and help manage anterior cruciate ligament injuries more efficiently. Hypothesis Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft can more closely restore normal knee anterior-posterior, medial-lateral, and internal-external kinematics than can conventional single-bundle anterior cruciate ligament reconstruction. Study Design Controlled laboratory study. Methods Kinematic responses after single-bundle anterior cruciate ligament reconstruction and single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft were compared with the intact knee in 9 fresh-frozen human cadaveric knee specimens using a robotic testing system. Kinematics of each knee were determined under an anterior tibial load (134 N), a simulated quadriceps load (400 N), and combined torques (10 Nm valgus and 5 Nm internal tibial torques) at 0°, 15°, 30°, 60°, and 90° of flexion. Results Anterior tibial translations were more closely restored to the intact knee level after single-tunnel double-bundle reconstruction with anatomical placement of hamstring tendon graft than with a single-bundle reconstruction under the 3 external loading conditions. Under simulated quadriceps load, the mean internal tibial rotations after both reconstructions were lower than that of the anterior cruciate ligament–intact knee with no significant differences between these 3 knee conditions at 0° and 30° of flexion (P > .05).The increased medial tibial shifts of the anterior cruciate ligament–deficient knees were restored to the intact level by both reconstruction techniques under the 3 external loading conditions. Conclusion Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft can better restore the anterior knee stability compared with a conventional single-bundle reconstruction. Both reconstruction techniques are efficient in restoring the normal medial-lateral stability but overcorrect the internal tibial rotations. Clinical Relevance Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft could provide improved clinical outcomes over a conventional single-bundle reconstruction.

Knee Abduction Affects Greater Magnitude of Change in ACL and MCL Strains Than Matched Internal Tibial Rotation In Vitro

“…Much of this work has evaluated and improved the efficaciousness of surgical methods and graft material selections used in ACL reconstructions with respect to native ACL biomechanics [12,15,19,20,28,35,43,49,51,[56][57][58]. These simulations have also gathered data on the mechanical contributions of the intact ACL in response to Lachman's and pivot shift tests [15,19,20,28,35,43,49,51,[56][57][58], gait cycles [23,39], and landing impact forces [32,40,41,46,52,53]. The accrued data have advanced the knowledge of ACL function and provided a baseline of comparison by which to evaluate the effectiveness of ACL injury treatments.…”

Single bundle anatomic anterior cruciate ligament reconstruction: Indications, technique and results

“…Alternatively, return to pre-injury level, overall IKDC, pivot shift and anterior laxities after single bundle and double bundle ACL reconstructions demonstrated that both techniques result in similar antero-posterior knee joint laxity at time 0. Therefore, no conclusive evidence on the superiority of one reconstruction technique over the other in terms of rotation laxity could be obtained 17 .…”

Graft tensioning in anterior cruciate ligament reconstruction

“…In the case of the STG autograft, a further delineation can be drawn with the potential for either a single or double bundle method (Branch, Siebold, Freedberg, & Jacobs, 2011;Chalmers et al, 2013;Gadikota et al, 2010;Jarvela, 2007;Lewis et al, 2008;van Eck et al, 2010). Although the proposition of a double bundle method has been around since the 1930's, the technique has become more popular in recent years with advancements in surgical methodology and the suggestion that it more closely resembles the native ACL; hence improving patient outcomes (Chalmers et al, 2013;Gadikota et al, 2010;Karlsson et al, 2011;Park et al, 2010;Schindler, 2012;van Eck et al, 2010).…”

“…Although the proposition of a double bundle method has been around since the 1930's, the technique has become more popular in recent years with advancements in surgical methodology and the suggestion that it more closely resembles the native ACL; hence improving patient outcomes (Chalmers et al, 2013;Gadikota et al, 2010;Karlsson et al, 2011;Park et al, 2010;Schindler, 2012;van Eck et al, 2010).…”

“…Pain, extension loss and inability to return to pre-injury levels of function are the most commonly reported limitations (Biau et al, 2007;Chalmers et al, 2013;Martins et al, 2008). The continual refinement of surgical methods to optimize the restoration of normal knee biomechanics is considered essential to minimizing such limitations (Gadikota et al, 2010;Seon et al, 2007). One such surgical variable is initial graft tension Kim et al, 2006;Kirwan, Bourke, Chipchase, Dalton, & Russell, 2013;Woo et al, 2006).…”