Comparable results between lateralized single- and double-bundle ACL reconstructions

Abstract

Patellar tendon autografts are not suitable for multibundle ACL reconstruction, a procedure that reportedly enhances postoperative knee stability. Biomechanical studies recommend lateral placement of the femoral tunnel for single-bundle reconstruction to improve postoperative knee kinematics. We asked whether a lateralized single-bundle patellar tendon graft (LSBP) would provide good short-term results of ACL reconstruction comparable to double-bundle hamstring tendon grafts (DBH). We prospectively followed 144 patients with unilateral ACL rupture treated with either LSBP or DBH in a nonrandomized fashion. Twenty-four female and 31 male patients with LSBP and 44 female and 26 male patients with DBH were followed for a minimum of 24 months (average, 38 months; range, 24-56 months). The patients with LSBP recovered knee extension better at 1 month compared with the patients with DBH, but extension was similar after 3 months. We observed no differences in the side-to-side difference of KT1000 measurement, pivot shift test, or anterior drawer test between LSBP and DBH. Although better recovery of hamstring strength in LSBP and better recovery of quadriceps strength in DBH were observed in the early postoperative period, these differences disappeared after 12 months. There was no difference in International Knee Documentation Committee objective evaluation between LSBP and DBH at the final followup.

Level of evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Fig. 1A–B

The photographs show the position of the tibial tunnel. (A) The tunnel dilator was inserted into the tibial tunnel placed on the anterior half of the ACL footprint in lateralized single-bundle reconstruction. (B) The gold dilator was inserted into the anteromedial tunnel placed on the anterior half of the footprint, and the silver dilator was inserted into the posterolateral tunnel placed on the posterior half of the footprint in double-bundle reconstruction.

Fig. 2A–B

The photographs show the direction of the tibial guidewire in (A) the coronal plane (α angle) and (B) sagittal plane (β angle). In the lateralized single-bundle reconstruction, the guidewire was inserted with 35° to 40° of the coronal angle (α angle) and 40° to 45° of the sagittal angle (β angle) from the tibial long axis. In double-bundle reconstruction, the α angle and β angle were 25° to 30° and 40° to 45° for the AMB and 35° to 40° and 30° to 35° for the PLB.

Fig. 3A–B

The oblique axial CT images of (A) the 10 o’clock and (B) 11 o’clock femoral tunnels. The images were reconstructed in the plane perpendicular to the intercondylar notch.

Fig. 4

A photograph shows the position of the femoral tunnel in lateralized single-bundle reconstruction. The virtual clock face was placed on the posterior wall of the intercondylar notch with 12 o’clock on the top of the intercondylar notch and 6 o’clock on the tibial surface under arthroscopic 0bservation. The femoral tunnel (gray circle) was placed at the 10 o’clock position in the right knee.

Fig. 5

A photograph shows the position of the femoral tunnel in double-bundle reconstruction. The femoral tunnel of the AMB (light blue circle) was placed between the 10 and 11 o’clock positions in the right knee. The femoral tunnel of the PLB (pink circle) was placed above the contact point between the lateral femoral condyle and the tibial plateau at 90° knee flexion.