Skip to main content
SpringerLink
Log in

Double bundle or single bundle plus extraarticular tenodesis in ACL reconstruction?

A CAOS study

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Anatomic reconstructions of anterior cruciate ligament (ACL) with double bundle gracilis and semitendonosus tendons graft, reproducing AM and PL bundles, have been introduced to offer a better biomechanical outcome, especially during rotatory loads. On the other hand, many methods of tenodesing the lateral aspect of the tibia to the femur to reduce internal rotation (IR) of the tibia and minimize anterior translation of the tibia relative to the femur as a backup for intra-articular reconstruction, have been also suggested. The goal of this study is to evaluate the effect, on the IR of the tibia, of a lateral reconstruction in addition to a standard single bundle ACL reconstruction as compared with an anatomic double bundle ACL reconstruction. Computer assisted ACL reconstruction has been used because it could be very effective in evaluating the global kinematic performance of the reconstructed knee. We selected 20 consecutive ACL reconstruction procedures to be performed in males in our hospital. Patients were alternately assigned to one of the two groups––group A: standard single bundle ACL reconstruction with doubled gracilis and semitendinosus tendons graft with an arthroscopically assisted two incisions technique and a lateral extraarticular reconstruction; group B: double bundle ACL reconstruction with doubled gracilis and semitendinosus tendons graft with an arthroscopically assisted two incisions technique. In all ACL reconstruction procedures navigation process was performed. Both surgical techniques reduced significantly AP displacement, IR and external rotation (ER) of the tibia respect to pre-operative ACL deficient condition (p < 0.05). Comparing the group A after the single bundle reconstruction and the group B after the AM bundle fixation, non differences were found in AP displacement, IR and ER of the tibia (p = 0.75, p = 0.07 and p = 0.07 respectively; power: 0.94). Comparing the group A after the addition of the lateral tenodesis and group B after the PL bundle fixation (AM + PL) no differences in AP tibial displacement and in ER of tibia were found (p = 0.9 and 0.15, respectively; power: 0.99); however a significant reduction in IR of the tibia was found in group A after the addition of the lateral tenodesis respect to the group B after the addition of the PL bundle (p = 0.0001; power: 0.26). On the basis of our study, the addition of a lateral extraarticular reconstruction to a standard single bundle ACL reconstruction with hamstrings tendons graft in an “in vivo” reconstruction, is more effective in reducing the IR of the tibia at 30° of knee flexion, as compared with a standard single bundle ACL reconstruction and with an anatomic double bundle reconstruction is confirmed.

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.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Aglietti P, Buzzi R, Giron F, Simeone AJ, Zaccherotti G (1997) Arthroscopicassisted anterior cruciate ligament reconstruction with the central third patellar tendon: a 5–8-year follow-up. Knee Surg Sports Traumatol Arthrosc 5:138–144

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  3. Bach BR Jr, Tradonsky S, Bojchuk J, Levy ME, Bush-Joseph CA, Khan NH (1998) Arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft: five- to nine-year follow-up evaluation. Am J Sports Med 26:20–29

    PubMed  Google Scholar 

  4. Barrett GR, Noojin FK, Hartzog CW, Nash CR (2002) Reconstruction of the anterior cruciate ligament in females: a comparison of hamstring versus patellar tendon autograft. Arthroscopy 18:46–54

    Article  PubMed  Google Scholar 

  5. Barrett GR, Richardson KJ (1995) The effect of added extra-articular procedure on results of ACL reconstruction. Am J Knee Surg 8:1–6

    PubMed  CAS  Google Scholar 

  6. Beynnon BD, Johnson RJ, Abate JA, et al (2005) Tratment of anterior cruciate ligament injuries, part I. Am J Sports Med 33:1579–1602

    Article  PubMed  Google Scholar 

  7. Bull A, Amis A (1998) The pivot-shift phenomenon: a clinical and biomechanical perspective. Knee 5:141–158

    Article  Google Scholar 

  8. Cha PS, Brucker PU, West RV, et al (2005) Arthroscopic double bundle anterior cruciate ligament reconstruction: an anatomic approach. Arthroscopy 21(10):1275e–1275e8

    Article  Google Scholar 

  9. Eichorn J (2004) Three years of experience with computer navigation assisted positioning of drilling tunnels in anterior cruciate ligament replacement (SS-67). Arthroscopy 20(supplement I):e31–e32

    Article  Google Scholar 

  10. Engebretsen L, Lew WD, Lewis JL, et al (1990) The effect of iliotibial tenodesis on intraarticular graft forces and knee joint motion. Am J Sports Med 18:169–176

    Article  PubMed  CAS  Google Scholar 

  11. Eriksson E (1997) How good are the results of ACL reconstruction? Knee Surg Sports Traumatol Arthrosc 5:137

    Article  PubMed  CAS  Google Scholar 

  12. Ferretti A., Conteduca F., Labianca L, et al (2005) Evolgate fixation of doubled flexor graft in ACL reconstruction: biomechanical evaluation with cyclic loading. Am J Sports Med 33(4):574–582

    Article  PubMed  Google Scholar 

  13. Ferretti A, Conteduca F, Morelli F, et al (2003) The evolgate, a method to improve the pull-out strength of interference screw in tibial fixation of ACL reconstruction with DGST. Arthroscopy 19(9):936–40

    Article  PubMed  Google Scholar 

  14. Frank CB, Jackson DW (1997) The science of reconstruction of the anterior cruciate ligament. J Bone Joint Surg Am 79:1556–1576

    PubMed  CAS  Google Scholar 

  15. Goertzen M, Schulitz KP (1993) [Comparison of combined extra- and intra-articular stabilization versus isolated arthroscopic semitendinosus repair after rupture of the anterior cruciate ligament]. Sportverletz Sportschaden 7:7–12 German

    Article  PubMed  CAS  Google Scholar 

  16. Ishibashi Y, Tsuda E, Tazawa K (2005) Intraoperative evaluation of the anatomical double dindle anterior cruciate ligament reconstruction with OrthoPilot navigation system. Orthopaedics 28(10/supplement):s1277–s1282

    Google Scholar 

  17. Kaplan N, Wickiewicz TL, Warren RF (1990) Primary surgical treatment of anterior cruciate ligament ruptures. A long-term followup study. Am J Sports Med 18:354–358

    Article  PubMed  CAS  Google Scholar 

  18. Kärrholm J, Selvik G, Elmqvist LG, et al (1988) Three-dimensional instability of the anterior cruciate deficient knee. J Bone Joint Surg Br 70:777–783

    PubMed  Google Scholar 

  19. Kocher MS, Steadman JR, Briggs K, Zurakowski D, Sterett WI, Hawkins RJ (2002) Determinants of patient satisfaction with outcome after anterior cruciate ligament reconstruction. J Bone Joint Surg Am 84:1560–1572

    PubMed  Google Scholar 

  20. Koh J (2005) Computer assisted navigation and anterior cruciate ligament reconstruction: accuracy and outcomes. Orthopaedics 28(10/supplement):s1283–s1288

    Google Scholar 

  21. Logan M, Dunstan E, Robinson J, et al (2004) Tibiofemoral kinematics of the anterior cruciate ligament (ACL)-deficient weightbearing, living knee employing vertical access open “Interventional” multiple resonance imaging. Am J Sports Med 32:720–726

    Article  PubMed  Google Scholar 

  22. MacIntosh DL, Darby JA (1976) Lateral substitution reconstruction. In: Proceedings of the Canadian Orthopaedic Association. J Bone Joint Surg Br 58:142

  23. Pearl AJ, Bergfeld JA, editors (1992) Extraarticular reconstruction in the anterior cruciate ligament deficient knee. Champaign, Human Kinetics

  24. Plaweski S, Cazal J, Rosell P, Merloz P (2006) Anterior cruciate ligament reconstruction using navigation A comparative study on 60 patients. Am J Sports Med 34(4):542–552

    Article  PubMed  Google Scholar 

  25. Ristanis S, Stergiou N, Patras K, Vasiliadis HS, Giakas G, Georgoulis AD (2005) Excessive tibial rotation during high-demand activities is not restored by anterior cruciate ligament reconstruction. Arthroscopy 21:1323–1329

    Article  PubMed  Google Scholar 

  26. Shelbourne KD, Gray T (1997) Anterior cruciate ligament reconstruction with autogenous patellar tendon graft followed by accelerated rehabilitation: a two- to nine-year follow-up. Am J Sports Med 25:786–795

    Article  PubMed  CAS  Google Scholar 

  27. Stulberg SD, Yafe MA, Koo SK (2006) Computer assisted surgery versus manual total knee arthroplasty: a case-controlled study. J Bone Joint Surg Am 88:47–54

    Article  PubMed  Google Scholar 

  28. 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 

  29. Terry GC, Hughston JC, Rose RM (1986) The anatomy of the iliopatellar band and iliotibial tract. Am J Sports Med 14:39–45

    Article  PubMed  CAS  Google Scholar 

  30. Valentin P, Hofbauer M, Aldrian S (2005) Clinical results of computer navigated anterior cruciate ligament reconstruction. Orthopaedics 28(10/supplement):s1289–s1291

    Google Scholar 

  31. Woo SLY, Kanamori A, Zeminski J, et al (2002) Anterior tibial and rotational loads with hamstrings and patellar tendon: a cadaveric study comparing the effectiveness of reconstruction of the anterior cruciate ligament. J Bone Joint Surg Am 84:907–914

    PubMed  Google Scholar 

  32. Yagi M, Wong EH, Kanamori A, et al (2002) Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med 30(5):660–666

    PubMed  Google Scholar 

  33. Yasuda K, Kondo E, Ichiyama H, et al (2004) Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts. Arthroscopy 20:1015–1025

    Article  PubMed  Google Scholar 

  34. Zaffagnini F, Marcacci M, Lo Presti M, et al (2006) Prospecitve and randomized evaluation of ACL reconstruction with three techniques: a clinical and radiographic evaluation at 5 years folow-up. Knee Surg Sports Traumatol Arthrosc 14:1060–1069

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orthopaedic Unit and “Kirk Kilgour” Sports Injury Center, Sant’Andrea Hospital, University “La Sapienza”, Rome, Italy

    E. Monaco, L. Labianca, F. Conteduca, A. De Carli & A. Ferretti

  2. Via D. di Buoninsegna 22, 00142, Rome, Italy

    E. Monaco

  3. Via Gambero 5, Taranto, Italy

    L. Labianca

  4. Via Flaminia 1761, 00188, Rome, Italy

    F. Conteduca

  5. Via di Val Cannuta 213, 00166, Rome, Italy

    A. De Carli

  6. Via Lidia 73, 00179, Rome, Italy

    A. Ferretti

Authors
  1. E. Monaco
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Labianca
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. Conteduca
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. De Carli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Ferretti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. Monaco.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Monaco, E., Labianca, L., Conteduca, F. et al. Double bundle or single bundle plus extraarticular tenodesis in ACL reconstruction?. Knee Surg Sports Traumatol Arthr 15, 1168–1174 (2007). https://doi.org/10.1007/s00167-007-0368-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-007-0368-y

Keywords

Search

Navigation