Skip to main content
SpringerLink
Log in

Comparative study between mono-bundle bone-patellar tendon-bone, double-bundle hamstring and mono-bundle bone-patellar tendon-bone combined with a modified Lemaire extra-articular procedure in anterior cruciate ligament reconstruction

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

The aim of the study was to compare three different procedures performed by the same surgeon: mono-bundle patellar tendon reconstruction (bone-patellar tendon-bone, BPTB), double-bundle hamstring reconstruction (DBH) and mono-bundle patellar tendon combined with extra-articular reconstruction (Lemaire) (BPTB + L).

Methods

A total of 75 patients (25 in each group) were evaluated at a mean follow-up of 25 months. Laxity was assessed pre- and post-operatively with Telos™ stress radiographs (15 kg). The amount of anterior tibial translation (ATT) corrected by the surgery was quantified. Secondary outcomes were International Knee Documentation Committee (IKDC) scores, pivot shift grading, pain complaints, sensory deficits, subsequent surgical procedures, return to sports and patients’ ability to kneel or squat on their affected knee.

Results

Absolute correction of ATT for the internal compartment was not statistically significant [analysis of variance (ANOVA), p = 0.377]. For the external compartment BPTB + L (8.2 mm) showed superiority over DBH (5.6 mm) and BPTB (4.1 mm) (ANOVA, p = 0.0001, Tukey’s test). Kneeling was better in the DBH group (ANOVA, p = 0.0001, Tukey’s test). In 22 patients it felt normal, while only in seven in the BPTB and eight in the BPTB + L groups. Sensory deficits were present in 11 patients from the DBH group, while in 17 in the BPTB and 19 in the BPTB + L groups (ANOVA, p = 0.052). Mean IKDC values, presence of anterior knee pain, subsequent operations, ability to squat and return to sports were not statistically different between groups.

Conclusions

Absolute correction of ATT was not statistically different for the medial compartment, but the patellar tendon reconstruction combined with the extra-articular procedure achieved the best lateral compartment ATT correction. Sensory deficits and kneeling seem to be worse in the groups where the patellar tendon is harvested.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Yasuda K, Tanabe Y, Kondo E, Kitamura N, Tohyama H (2010) Anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 26(9 Suppl):S21–S34

    PubMed  Google Scholar 

  2. Aglietti P, Giron F, Losco M, Cuomo P, Ciardullo A, Mondanelli N (2010) Comparison between single- and double-bundle anterior cruciate ligament reconstruction: a prospective, randomized, single-blinded clinical trial. Am J Sports Med 38(1):25–34

    Article  PubMed  Google Scholar 

  3. Järvelä T (2007) Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective, randomize clinical study. Knee Surg Sports Traumatol Arthrosc 15(5):500–507

    Article  PubMed  Google Scholar 

  4. Siebold R, Dehler C, Ellert T (2008) Prospective randomized comparison of double-bundle versus single-bundle anterior cruciate ligament reconstruction. Arthroscopy 24(2):137–145

    Article  PubMed  Google Scholar 

  5. Aglietti P, Giron F, Buzzi R, Biddau F, Sasso F (2004) Anterior cruciate ligament reconstruction: bone-patellar tendon-bone compared with double semitendinosus and gracilis tendon grafts. A prospective, randomized clinical trial. J Bone Joint Surg Am 86-A(10):2143–2155

    PubMed  Google Scholar 

  6. Aune AK, Holm I, Risberg MA, Jensen HK, Steen H (2001) Four-strand hamstring tendon autograft compared with patellar tendon-bone autograft for anterior cruciate ligament reconstruction. A randomized study with two-year follow-up. Am J Sports Med 29(6):722–728

    PubMed  CAS  Google Scholar 

  7. Shaieb MD, Kan DM, Chang SK, Marumoto JM, Richardson AB (2002) A prospective randomized comparison of patellar tendon versus semitendinosus and gracilis tendon autografts for anterior cruciate ligament reconstruction. Am J Sports Med 30(2):214–220

    PubMed  Google Scholar 

  8. Anderson AF, Snyder RB, Lipscomb AB Jr (2001) Anterior cruciate ligament reconstruction. A prospective randomized study of three surgical methods. Am J Sports Med 29(3):272–279

    PubMed  CAS  Google Scholar 

  9. Webster KE, Feller JA, Hameister KA (2001) Bone tunnel enlargement following anterior cruciate ligament reconstruction: a randomised comparison of hamstring and patellar tendon grafts with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 9(2):86–91

    Article  PubMed  CAS  Google Scholar 

  10. Feller JA, Webster KE (2003) A randomized comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction. Am J Sports Med 31(4):564–573

    PubMed  Google Scholar 

  11. Samuelsson K, Andersson D, Karlsson J (2009) Treatment of anterior cruciate ligament injuries with special reference to graft type and surgical technique: an assessment of randomized controlled trials. Arthroscopy 25(10):1139–1174

    Article  PubMed  Google Scholar 

  12. Marcacci M, Zaffagnini S, Giordano G, Iacono F, Presti ML (2009) Anterior cruciate ligament reconstruction associated with extra-articular tenodesis: a prospective clinical and radiographic evaluation with 10- to 13-year follow-up. Am J Sports Med 37(4):707–714

    Article  PubMed  Google Scholar 

  13. Lerat JL, Mandrino A, Besse JL, Moyen B, Brunet-Guedj E (1997) Effect of external extra-articular ligament plasty on the results of anterior cruciate ligament reconstruction with patellar tendon, a 4 years follow-up. Rev Chir Orthop Reparatrice Appar Mot 83(7):591–601

    PubMed  CAS  Google Scholar 

  14. Noyes FR, Barber SD (1991) The effect of an extra-articular procedure on allograft reconstructions for chronic ruptures of the anterior cruciate ligament. J Bone Joint Surg Am 73(6):882–892

    PubMed  CAS  Google Scholar 

  15. van Eck CF, Schreiber VM, Mejia HA, Samuelsson K, van Dijk CN, Karlsson J, Fu FH (2010) “Anatomic” anterior cruciate ligament reconstruction: a systematic review of surgical techniques and reporting of surgical data. Arthroscopy 26(9 Suppl):S2–S12

    PubMed  Google Scholar 

  16. Condouret J, Cohn J, Ferret J-M, Lemonsu A, Vasconcelos W, Dejour D, Potel J-F et al (2008) Isokinetic assessment with two years follow-up of anterior cruciate ligament reconstruction with patellar tendon or hamstring tendons. Rev Chir Orthop Reparatrice Appar Mot 94(8 Suppl):375–382

    Article  PubMed  CAS  Google Scholar 

  17. Prado RK, Ntagiopoulos PG, Fucs PMB, Severino NR, Dejour D (2012) A new technique in double-bundle anterior cruciate ligament reconstruction using implant-free femoral fixation. Int Orthop 36(7):1479–1485, discussion 1539–1541

    Article  PubMed  Google Scholar 

  18. Dejour H, Dejour D, Aït Si Selmi T (1999) Chronic anterior laxity of the knee treated with free patellar graft and extra-articular lateral plasty: 10-year follow-up of 148 cases. Rev Chir Orthop Reparatrice Appar Mot 85(8):777–789, 85

    PubMed  CAS  Google Scholar 

  19. Lemaire M (1967) Rupture ancienne du ligament croisé antérieur du genou; fréquence, clinique, traitement (46 cas). J Chirurgie 311–320

  20. Beldame J, Bertiaux S, Roussignol X, Lefebvre B, Adam J-M, Mouilhade F, Dujardin F (2011) Laxity measurements using stress radiography to assess anterior cruciate ligament tears. Orthop Traumatol Surg Res 97(1):34–43

    Article  PubMed  CAS  Google Scholar 

  21. Jacobsen K (1976) Stress radiographical measurement of the anteroposterior, medial and lateral stability of the knee joint. Acta Orthop Scand 47(3):335–334

    Article  PubMed  CAS  Google Scholar 

  22. Kartus J, Magnusson L, Stener S, Brandsson S, Eriksson BI, Karlsson J (1999) Complications following arthroscopic anterior cruciate ligament reconstruction. A 2-5-year follow-up of 604 patients with special emphasis on anterior knee pain. Knee Surg Sports Traumatol Arthrosc 7(1):2–8

    Article  PubMed  CAS  Google Scholar 

  23. Laxdal G, Sernert N, Ejerhed L, Karlsson J, Kartus JT (2007) A prospective comparison of bone-patellar tendon-bone and hamstring tendon grafts for anterior cruciate ligament reconstruction in male patients. Knee Surg Sports Traumatol Arthrosc 15(2):115–125

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Lyon-Ortho-Clinic; Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France

    David Dejour & Nicolas Bonin

  2. Hospital São Rafael, Avenida São Rafael 2512, 41253-900, Salvador, BA, Brazil

    Wilson Vanconcelos

  3. Instituto de Ortopedia e Traumatologia de Passo Fundo, Rua Uruguai 2050, 99010-111, Passo Fundo, RS, Brazil

    Paulo Renato Fernandes Saggin

Authors
  1. David Dejour
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wilson Vanconcelos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicolas Bonin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paulo Renato Fernandes Saggin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paulo Renato Fernandes Saggin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dejour, D., Vanconcelos, W., Bonin, N. et al. Comparative study between mono-bundle bone-patellar tendon-bone, double-bundle hamstring and mono-bundle bone-patellar tendon-bone combined with a modified Lemaire extra-articular procedure in anterior cruciate ligament reconstruction. International Orthopaedics (SICOT) 37, 193–199 (2013). https://doi.org/10.1007/s00264-012-1718-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-012-1718-z

Keywords

Search

Navigation