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. 2010 Apr;38(4):713-20.
doi: 10.1177/0363546509353406. Epub 2010 Feb 5.

Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft: can it restore normal knee joint kinematics?

Hemanth R Gadikota  1 , Jia-Lin Wu, Jong Keun Seon, Karen Sutton, Thomas J Gill, Guoan Li
Affiliations

Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft: can it restore normal knee joint kinematics?

Hemanth R Gadikota et al. Am J Sports Med. 2010 Apr.

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 N.m valgus and 5 N.m internal tibial torques) at 0 degrees , 15 degrees , 30 degrees , 60 degrees , and 90 degrees 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 degrees and 30 degrees 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.

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Conflict of interest statement

The authors declared that they had no conflicts of interests in their authorship and publication of this contribution.

Figures

Figure 1
Figure 1
Single-bundle (A) and anatomical single-tunnel (B) ACL reconstructions. AMB, anteromedial bundle; PLB, pos-terolateral bundle.
See this image and copyright information in PMC

References

    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 tenodesis. Am J Sports Med. 1992;20(1):38–45. - PubMed
    1. Aglietti P, Zaccherotti G, Simeone AJ, Buzzi R. Anatomic versus non-anatomic tibial fixation in anterior cruciate ligament reconstruction with bone–patellar tendon-bone graft. Knee Surg Sports Traumatol Arthrosc. 1998;6(suppl 1):S43–S48. - PubMed
    1. Barber FA, Spruill B, Sheluga M. The effect of outlet fixation on tunnel widening. Arthroscopy. 2003;19(5):485–492. - PubMed
    1. Beynnon BD, Johnson RJ, Abate JA, Fleming BC, Nichols CE. Treatment of anterior cruciate ligament injuries, part I. Am J Sports Med. 2005;33(10):1579–1602. - PubMed
    1. Brucker PU, Lorenz S, Imhoff AB. Aperture fixation in arthroscopic anterior cruciate ligament double-bundle reconstruction. Arthroscopy. 2006;22(11):1250, e1251–e1256. - PubMed

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