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. 2020 Dec;23(6):341-345.
doi: 10.1016/j.cjtee.2020.04.007. Epub 2020 Apr 30.

Analysis of modified double-bundle anterior cruciate ligament reconstruction with implantless fixation on tibial side

Skand Sinha  1 , Ananta K Naik  2 , Appan Kumar  2 , Tista Jacob  2 , Santanu Kar  2
Affiliations

Analysis of modified double-bundle anterior cruciate ligament reconstruction with implantless fixation on tibial side

Skand Sinha et al. Chin J Traumatol. 2020 Dec.

Abstract

Purpose: To avoid potential problems of double-bundle anterior cruciate ligament reconstruction (ACLR), various modifications have been reported. This study analyzed a novel technique of modified double-bundle (MDB) ACLR without implant on tibial side in comparison to single-bundle (SB) ACLR.

Methods: Eighty cases of isolated anterior cruciate ligament tear (40 each in SB group or MDB group) were included. SB ACLR was performed by outside in technique with quadrupled hamstring graft fixed with interference screws. In MDB group, ACLR harvested tendons were looped over each other at the center and free ends whipstitched. Femoral tunnel was created by outside in technique. Anteromedial tibial tunnel was created with tibial guide at 55°. The anatomic posterolateral aiming guide (Smith-Nephew) was used to create posterolateral tunnel. With the help of shuttle sutures, the free end of gracillis was passed through posterolateral tunnel to femoral tunnel followed by semitendinosus graft through anteromedial tunnel to femoral tunnel. On tibial side the graft was looped over bone-bridge between external apertures of anteromedial and posterolateral tunnel. Graft was fixed with interference screw on femoral side in 10° knee flexion. International Knee Documentation Committee (IKDC), Tegner score, Pivot shift and knee laxity test (KLT, Karl-Storz) were recorded pre- and post-surgery. At one year magnetic resonance imaging (MRI) was done. Statistical analysis was done by SPSS software.

Results: Mean preoperative KLT reading of (10.00 ± 1.17) mm in MDB group improved to (4.10 ± 0.56) mm and in SB group it improved from (10.00 ± 0.91) mm to (4.80 ± 0.46) mm. The mean preoperative IKDC score in MDB group improved from (49.49 ± 8.00) to (92.5 ± 1.5) at one year and that in SB group improved from (52.5 ± 6.9) to (88.4 ± 2.6). At one-year 92.5% cases in MDB group achieved their preinjury Tegner activity level as compared to 60% in SB group. The improvement in IKDC, KLT and Tegner scale of MDB group was superior to SB group. MRI confirmed graft integrity at one year and clinically at 2 years.

Conclusion: MDB ACLR has shown better outcome than SB ACLR. It is a simple technique that does not require fixation on tibial side and resultant graft is close to native ACL.

Keywords: Anterior cruciate ligament reconstruction; Fracture fixation; Tibia.

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Figures

Fig. 1
Fig. 1
Semitendinosus and gracillis looped over each other and free ends are whipstitched.
Fig. 2
Fig. 2
Distance between anteromedial and posterolateral guide pins on tibial foot print of anterior cruciate ligament.
Fig. 3
Fig. 3
(A) Shuttle sutures are passed through anteromedial and posterolateral tunnels from tibia to femur. (B) Posterolateral graft is seated first. (C) Graft seating on bone-bridge between anteromedial and posterolateral external aperture on tibia. (D) Interference screw fixation by outside in technique on femoral side.
Fig. 4
Fig. 4
Final intra-articular graft construct.
Fig. 5
Fig. 5
Follow-up magnetic resonance imaging showing two distinct low signal bundles of anterior cruciate ligament.
See this image and copyright information in PMC

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