Skip to main content
Log in

Patient selection of anatomical double bundle or traditional single bundle ACL reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study was designed as a questionnaire survey to reveal the preference in technique of patients faced with anterior cruciate ligament (ACL) reconstruction.

Methods

One hundred and ten subjects (35 patients and 75 medical students) were included in this study. A questionnaire survey was conducted, and the following questions were asked: (1) How old are you? (2) Prior to this survey, did you know what the ACL was? (3) Prior to this survey, did you have any knowledge about ACL reconstruction technique? (4) Prior to this survey, did you know the difference between anatomical double bundle (DB) technique and traditional single bundle (SB) technique? (5) If you had to have an ACL reconstruction, which technique would you prefer? In the same questionnaire, between questions (3) and (4), a description of SB and DB was provided.

Results

Sixty-nine percent of patients and 100% of medical students knew what the ACL was. Forty-three percent of patients and 85% of medical students had previous knowledge about ACL reconstruction. None of the patients and only 29% of the medical students had prior knowledge about the difference between DB and SB. Six percent of patients selected SB, and 40% selected DB. Nine percent of medical students selected SB, and 67% selected DB.

Conclusion

In this study, 46% of patients and 76% of medical students selected one of the operation techniques. The trend in selection of the operation technique was significantly influenced by the subjects’ prior medical knowledge. It might be possible to apply the principle of “informed patient choice” to the selection of DB or SB for ACL reconstruction.

Level of evidence

Decision analysis, Level III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Abbreviations

ACL:

Anterior cruciate ligament

DB:

Double bundle

SB:

Single bundle

References

  1. Buoncristiani AM, Tjoumakaris FP, Starman JS, Ferretti M, Fu FH (2006) Anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 22:1000–1006

    Article  PubMed  Google Scholar 

  2. Englund M (2010) The role of biomechanics in the initiation and progression of OA of the knee. Best Pract Res Clin Rheumatol 24:39–46

    Article  PubMed  Google Scholar 

  3. Ferretti M, Ekdahl M, Shen W, Fu FH (2007) Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy 23:1218–1225

    Article  PubMed  Google Scholar 

  4. Griffin LY, Agel J, Albohm MJ et al (2000) Noncontact anterior cruciate ligament injuries. J Am Acad Orthop Surg 8:141–150

    PubMed  CAS  Google Scholar 

  5. Harner CD, Vogrin TM (2002) What’s new in sports medicine. J Bone Jt Surg Am 84:1095–1099

    Google Scholar 

  6. Iriuchishima T, Horaguchi T, Kubomura T, Morimoto Y, Fu FH (2011) Evaluation of the intercondylar roof impingement after anatomical double-bundle anterior cruciate ligament reconstruction using 3D-CT. Knee Surg Sports Traumatol Arthrosc 19:674–679

    Article  PubMed  Google Scholar 

  7. Iriuchishima T, Ingham SJ, Tajima G et al (2010) Evaluation of the tunnel placement in the anatomical double-bundle ACL reconstruction: a cadaver study. Knee Surg Sports Traumatol Arthrosc 18:1226–1231

    Article  PubMed  Google Scholar 

  8. Iriuchishima T, Tajima G, Ingham SJ, Shen W, Smolinski P, Fu FH (2010) Impingement pressure in the anatomical and non anatomical anterior cruciate ligament reconstruction: a cadaver study. Am J Sports Med 38:1611–1617

    Article  PubMed  Google Scholar 

  9. Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL (2003) Knee stability and graft function following anterior cruciate ligament reconstruction: comparison between 11 O’clock and 10 O’clock femoral tunnel placement. Arthroscopy 19:297–304

    Article  PubMed  Google Scholar 

  10. Mae T, Shino K, Miyama T et al (2001) Single versus two-femoral socket anterior cruciate ligament reconstruction technique: biomechanical analysis using a robotic simulator. Arthroscopy 17:708–716

    Article  PubMed  CAS  Google Scholar 

  11. Moulton B, King JS (2010) Aligning ethics with medical decision-making: the quest for informed patient choice. J Law Med Ethics 38:85–97

    Article  PubMed  Google Scholar 

  12. Muneta T, Koga H, Mochizuki T et al (2007) A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double bundle techniques. Arthroscopy 23:618–628

    Article  PubMed  Google Scholar 

  13. Seon JK, Song EK, Bae BH et al (2007) Kinematic study following double-bundle, anterior cruciate ligament reconstruction. Int Orthop 31:623–628

    Article  PubMed  Google Scholar 

  14. Siebold R, Benetos IS, Sartory N, He Z, Hariri N, Passler HH (2010) How to avoid the risk of intraoperative cartilage damage in anatomic four tunnel double bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18:64–67

    Article  PubMed  Google Scholar 

  15. Steiner ME, Murray MM, Rodeo SA (2008) Strategies to improve anterior cruciate ligament healing and graft placement. Am J Sports Med 36:176–189

    Article  PubMed  Google Scholar 

  16. Tajima G, Iriuchishima T, Ingham SJ et al (2010) Anatomic double-bundle anterior cruciate ligament reconstruction restores patellofemoral contact areas and pressures more closely than nonanatomic single-bundle reconstruction. Arthroscopy 26:1302–1310

    Article  PubMed  Google Scholar 

  17. Takeda Y, Sato R, Ogawa T, Fujii K, Naruse A (2009) In vivo resonance imaging measurement of tibiofemoral relation with different knee flexion angles after single- and double-bundle anterior cruciate ligament reconstructions. Arthroscopy 25:733–741

    Article  PubMed  Google Scholar 

  18. Tashman S, Collon D, Anderson K, Kolowich P, Anderst W (2004) Abnormal rotational knee motion during running after anterior cruciate ligament reconstruction. Am J Sports Med 32:975–983

    Article  PubMed  Google Scholar 

  19. Tsarouhas A, Iosifidis M, Kotzamitelos D, Spyropoulos G, Tsatalas T, Giakas G (2010) Thee-dimensional kinematic and kinetic analysis of knee rotational stability after single- and double-bundle- anterior cruciate ligament reconstruction. Arthroscopy 26:885–893

    Article  PubMed  Google Scholar 

  20. Van Eck CF, Schreiber VM, Liu TT, Fu FH (2010) The anatomic approach to primary, revision and augmentation anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1154–1163

    Article  PubMed  Google Scholar 

  21. Weinstein JN, Clay K, Morgan TS (2007) Informed patient choice: patient-centered valuing of surgical risks and benefits. Health Aff (Millwood) 26:726–730

    Article  Google Scholar 

  22. Yagi M, Wong EK, Kanamori A, Debski RE, Fu FH, Woo SL (2002) Biomechanical analysis of anatomic anterior cruciate ligament reconstruction. Am J Sports Med 30:660–666

    PubMed  Google Scholar 

  23. Yasuda K, Kondo E, Ichiyama H, Tanabe Y, Tohyama H (2006) Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: comparisons among 3 different procedures. Arthroscopy 22:240–251

    Article  PubMed  Google Scholar 

  24. Zantop T, Wellmann M, Fu FH, Petersen W (2008) Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction: anatomic and radiographic findings. Am J Sports Med 36:65–72

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Takanori Iriuchishima.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Iriuchishima, T., Koyama, T., Shirakura, K. et al. Patient selection of anatomical double bundle or traditional single bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 21, 571–575 (2013). https://doi.org/10.1007/s00167-012-1930-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-012-1930-9

Keywords

Navigation