Abstract
Purpose
This case-series outcome study presents a surgical technique for anatomic double-bundle anterior cruciate ligament (ACL) reconstruction with 4-tunnel using two interference screws. There was a 2-year minimum follow-up.
Methods
From January to December 2009, an ACL 4-tunnel, anatomic, double-bundle reconstruction was performed on 27 patients. Double-strand hamstring tendon grafts were used in each femoral tunnel as well as two interference screws. Tibial fixation was insured through manual tension, by tying non-absorbable sutures on the bone bridge between the two tunnels at 20° of knee flexion. Clinical assessments included the International Knee Documentation Committee (IKDC) and Lysholm knee scores, range of motion (ROM), pivot-shift test, single-leg hop, and quadriceps-hamstrings strength tests using a hand-held dynamometer. Anterior knee laxity was also assessed using a rolimeter. A single examiner performed all testing pre-operatively at 6 months and during the 2-year follow-up.
Results
All patients were assessed during the 2-year follow-up. At that time, 92 % of the patients presented normal anterior laxity (average, 1.3 ± 0.5 mm) and rotational knee stability. No statistical side-to-side difference was found for ROM, muscle strength, single-leg hop, and function (n.s.). All patients presented a normal knee function according to the IKDC and the Lysholm score. In addition, no infection, graft failure, or pain were observed at the harvesting site.
Conclusion
The study shows that satisfactory results in relation to knee laxity, function, and strength can be achieved with the implant-free tibial fixation in the ACL double-bundle reconstruction with two interference screws.
Level of evidence
Therapeutic case series, Level IV.
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References
Adachi N, Ochi M, Uchio Y et al (2004) Reconstruction of the anterior cruciate ligament single- versus double-bundle multistranded hamstring tendons. J Bone Joint Surg Br 86(4):515–520
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
Alexander JW, Gold JE, Icenogle KD, Noble PC, Lowe WR (2010) Anatomic double-bundle anterior cruciate ligament reconstruction: kinematics and knee flexion angle-graft tension relation. Arthroscopy 26:202–213
Asagumo H, Kimura M, Kobayashi Y et al (2007) Anatomic reconstruction of the anterior cruciate ligament using double-bundle hamstring tendons: surgical techniques, clinical outcomes, and complications. Arthroscopy 23(6):602–606
Augustsson J, Thomee R, Karlsson J (2004) Ability of a new hop test to determine functional déficits after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 12:350–355
Bohannon RW (1990) Hand-held compared with isokinetic dynamometry for measurement of static knee extension torque (parallel reliability of dynamometers. Clin Phys Physiol Meas 11:217–222
Brophy RH, Wright RW, Matava M (2010) Cost analysis of converting from single to double anterior cruciate ligament reconstruction. Am J Sports Med 37(4):683–687
Carneiro M, Navarro RD, Nakama GY, Barreto JM, Queiroz AAB, Luzo MVM (2009) Arthroscopy double-bundle reconstruction of anterior cruciate ligament using hamstring tendon grafts fixation with two interference screws. Rev Bras Ortop 44:441–445
Fukuda TY, Fingerhut D, Moreira VC et al (2013) Open kinetic chain exercises in a restricted range of motion after anterior cruciate ligament reconstruction: a randomized clinical trial. Am J Sports Med 41(4):788–794
Georgoulis AD, Papadonikolakis A, Papageorgiou CD et al (2003) Three-dimensional tibiofemoral kinematics of the anterior cruciate ligament-deficient and reconstructed knee during walking. Am J Sports Med 31(1):75–79
Izawa T, Okazaki K, Tashiro Y, Matsubara H, Miura H, Matsuda S, Hashizume M, Iwamoto Y (2011) Comparison of rotatory stability after anterior cruciate ligament reconstruction between single-bundle and double-bundle techniques. Am J Sports Med 39:1470–1477
Keays SL, Bullock-Saxton JE, Keays AC, Newcombe PA, Bullock MI (2007) A 6-year follow-up of the effect of graft site on strength, stability, range of motion, function, and joint degeneration after anterior cruciate ligament reconstruction: patellar tendon versus semitendinosus and gracilis tendon graft. Am J Sports Med 35(5):729–739
Komzák M, Hart R, Okál F, Safi A (2012) Does the posterolateral bundle influence rotational movement more than the anteromedial bundle in anterior cruciate ligament reconstruction?: A clinical study. J Bone Joint Surg Br 94(10):1372–1376
Kondo E, Yasuda K, Azuma H, Tanabe Y, Yagi T (2008) Prospective clinical comparisons of anatomic double-bundle versus single-bundle anterior cruciate ligament reconstruction procedures in 328 consecutive patients. Am J Sports Med 36:1675–1687
Kondo E, Yasuda K, Miyatake S, Kitamura N, Tohyama H, Yagi T (2012) Clinical comparison of two suspensory fixation devices for anatomic double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20(7):1261–1267
Kousa P, Järvinen TLN, Vihavainen M, Kannus P, Järvinen M (2003) The fixation strength of six hamstring tendon graft fixation devices in anterior cruciate ligament reconstruction. Part I: femoral site. Am J Sports Med 31:174–181
Magalhães E, Fukuda TY, Sacramento SN, Forgas A, Cohen M, Abdalla RJ (2010) A comparison of hip strength between sedentary females with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther 40(10):641–647
Muellner T, Bugge W, Johansen S, Holtan C, Engebretsen L (2001) Inter- and intratester comparison of the rolimeter knee tester: effect of tester’s experience and the examination technique. Knee Surg Sports Traumatol Arthrosc 9:302–306
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 doublebundle techniques. Arthroscopy 23(6):618–628
Myer GD, Paterno MV, Ford KR, Hewett TE (2006) Rehabilitation after anterior cruciate ligament reconstruction: criteria-based progression through the return-to-sport phase. J Orthop Sports Phys Ther 36:385–402
Pinczewski LA, Deehan DJ, Salmon LJ, Russell VJ, Clingeleffer A (2002) A five-year comparison of patellar tendon versus four-strand hamstring tendon autograft for arthroscopic reconstruction of the anterior cruciate ligament. Am J Sports Med 30:523–536
Ristanis S, Giakas G, Papageorgiou CD et al (2003) The effects of anterior cruciate ligament reconstruction on tibial rotation during pivoting after descending stairs. Knee Surg Sports Traumatol Arthrosc 11(6):360–365
Robinson RL, Nee RJ (2007) Analysis of hip strength in females seeking physical therapy treatment for unilateral patellofemoral pain syndrome. J Orthop Sports Phys Ther 37:232–238
Seon JK, Gadikota HR, Wu JL, Sutton K, Gill TJ, Li G (2010) Comparison of single- and double-bundle anterior cruciate ligament reconstructions in restoration of knee kinematics and anterior cruciate ligament forces. Am J Sports Med 38(7):1359–1367
Suomalainen P, Järvelä T, Paakkala A, Kannus P, Järvinen M (2012) Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective randomized study with 5-year results. Am J Sports Med 40:1511–1518
Trudelle-Jackson E, Jackson AW, Frankowski CM, Long KM, Meske NB (1994) Interdevice reliability and validity assessment of the nicholas hand-held dynamometer. J Orthop Sports Phys Ther 20(6):302–306
Van Eck CF, Kopf S, Irrgang JJ, Blankevoort L, Bhandari M, Fu FH, Poolman RW (2012) Single-bundle versus double-bundle reconstruction for anterior cruciate ligament rupture: a meta-analysis—does anatomy matter? Arthroscopy 28:405–424
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
Yamamoto Y, Hsu WH, Woo SL, Van Scyoc AH, Takakura Y, Debski RE (2004) Knee stability and graft function after anterior cruciate ligament reconstruction a comparison of a lateral and an anatomic femoral tunnel placement. Am J Sports Med 32:1825–1832
Zantop T, Herbort M, Raschke MJ, Fu FH, Petersen W (2007) The role of the anteromedial and posterolateral bundles of the anterior cruciate ligament in anterior tibial translation and internal rotation. Am J Sports Med 35:223–227
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Sacramento, S.N., Magalhães, E., Christel, P. et al. A new technique in double-bundle anterior cruciate ligament reconstruction with implant-free tibial fixation. Knee Surg Sports Traumatol Arthrosc 24, 2831–2837 (2016). https://doi.org/10.1007/s00167-014-3430-6
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DOI: https://doi.org/10.1007/s00167-014-3430-6