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. 2009 May;37(5):962-9.
doi: 10.1177/0363546508330145. Epub 2009 Mar 4.

Biomechanical comparison of single-tunnel-double-bundle and single-bundle anterior cruciate ligament reconstructions

Hemanth R Gadikota  1 , Jong Keun Seon, Michal Kozanek, Luke S Oh, Thomas J Gill, Kenneth D Montgomery, Guoan Li
Affiliations

Biomechanical comparison of single-tunnel-double-bundle and single-bundle anterior cruciate ligament reconstructions

Hemanth R Gadikota et al. Am J Sports Med. 2009 May.

Abstract

Background: Anatomic double-bundle reconstruction has been thought to better simulate the anterior cruciate ligament anatomy. It is, however, a technically challenging procedure, associated with longer operation time and higher cost.

Hypothesis: Double-bundle anterior cruciate ligament reconstruction using a single femoral and tibial tunnel can closely reproduce intact knee kinematics.

Study design: Controlled laboratory study.

Methods: Eight fresh-frozen human cadaveric knee specimens were tested using a robotic testing system to investigate the kinematic response of the knee joint under an anterior tibial load (130 N), simulated quadriceps load (400 N), and combined torques (5 N.m valgus and 5 N.m internal tibial torques) at 0 degrees, 15 degrees, 30 degrees, 60 degrees, and 90 degrees of flexion. Each knee was tested sequentially under 4 conditions: (1) anterior cruciate ligament intact, (2) anterior cruciate ligament deficient, (3) single-bundle anterior cruciate ligament reconstruction using quadrupled hamstring tendon, and (4) single-tunnel-double-bundle anterior cruciate ligament reconstruction using the same tunnels and quadrupled hamstring tendon graft as in the single-bundle anterior cruciate ligament reconstruction.

Results: Single-tunnel-double-bundle anterior cruciate ligament reconstruction more closely restored the intact knee kinematics than single-bundle anterior cruciate ligament reconstruction at low flexion angles (< or =30 degrees ) under the anterior tibial load and simulated muscle load (P < .05). However, single-tunnel-double-bundle anterior cruciate ligament reconstruction overconstrained the knee joint at high flexion angles (> or =60 degrees ) under the anterior tibial load and at 0 degrees and 30 degrees of flexion under combined torques.

Conclusion: This double-bundle anterior cruciate ligament reconstruction using a single tunnel can better restore anterior tibial translations to the intact level compared with single-bundle anterior cruciate ligament reconstruction at low flexion angles, but it overconstrained the knee joint at high flexion angles.

Clinical relevance: This technique could be an alternative for both single-bundle and double-tunnel-double-bundle anterior cruciate ligament reconstructions to reproduce intact knee kinematics and native anterior cruciate ligament anatomy.

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Conflict of interest statement

One or more of the authors has declared a potential conflict of interest: Dr Montgomery is on the Clinical Advisory Board for and owns stocks in Cayenne Medical.

Figures

Figure 1
Figure 1
Schematic representation of single-bundle (A) and single-tunnel–double-bundle (B) ACL reconstructions. AMB, anteromedial bundle; PLB, posterolateral bundle.
Figure 2
Figure 2
Schematic illustration of the femoral implant and the separation of the 2 bundles in the femoral tunnel (A) and the tibial implant and the separation of the 2 bundles in the tibial tunnel (B). AMB, anteromedial bundle; PLB, posterolateral bundle.
Figure 3
Figure 3
Anterior tibial translation under anterior tibial load in the 4 different knee conditions. Anterior tibial translations of the ACL-deficient knee were significantly different from the intact, single-bundle ACL-reconstructed, and single-tunnel–double-bundle ACL-reconstructed knee at all flexion angles. Error bars represent standard deviation. *P < .05. Recon, reconstruction.
Figure 4
Figure 4
Tibial translation under quadriceps load in the 4 different knee conditions. Tibial translations of the ACL-deficient knee were significantly different from the intact, single-bundle ACL-reconstructed and the single-tunnel–double-bundle ACL-reconstructed knee at all flexion angles. +Anterior tibial translation; −posterior tibial translation; *P <.05. Error bars represent standard deviation. Recon, reconstruction.
Figure 5
Figure 5
Tibial rotations under the simulated quadriceps load in the 4 different knee conditions. +Internal tibial rotations; −external tibial rotations. Error bars represent standard deviation. Recon, reconstruction.
Figure 6
Figure 6
Internal tibial rotations under combined torques in the 4 different knee conditions. Error bars represent standard deviation. *P < .05. Recon, reconstruction.
See this image and copyright information in PMC

References

    1. Abramowitch SD, Papageorgiou CD, Withrow JD, Gilbert TW, Woo SL. The effect of initial graft tension on the biomechanical properties of a healing ACL replacement graft: a study in goats. J Orthop Res. 2003;21:708–715. - PubMed
    1. Adachi N, Ochi M, Uchio Y, Iwasa J, Kuriwaka M, Ito Y. Reconstruction of the anterior cruciate ligament: single- versus double-bundle multi-stranded hamstring tendons. J Bone Joint Surg Br. 2004;86:515–520. - PubMed
    1. Aglietti P, Buzzi R, D’Andria S, Zaccherotti G. Long-term study of anterior cruciate ligament reconstruction for chronic instability using the central one-third patellar tendon and a lateral extraarticular teno-desis. Am J Sports Med. 1992;20:38–45. - PubMed
    1. Aglietti P, Giron F, Cuomo P, Losco M, Mondanelli N. Single- and double-incision double-bundle ACL reconstruction. Clin Orthop Relat Res. 2007;454:108–113. - PubMed
    1. Albuquerque RFM, Sasaki SU, Amatuzzi MM, Angelini FJ. Anterior cruciate ligament reconstruction with double bundle versus single bundle: experimental study. Acta Ortop Bras. 2007;3:335–344. - PubMed

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