Skip to main content

Comparison of outcome after anatomic double-bundle and antero-medial portal non-anatomic single-bundle reconstruction in ACL-injured patients

Knee Surgery, Sports Traumatology, Arthroscopy volume 25, pages 1307–1315 (2017)Cite this article

Abstract

Purpose

The aim of this study was to compare anatomic double-bundle anterior cruciate ligament reconstruction with non-anatomic single-bundle reconstruction.

Methods

In a prospective consecutive series, 94 unselected patients [45 anatomic double-bundle (ADB) and 49 non-anatomic single-bundle (SB)] underwent ACL reconstruction involving hamstring tendon autograft, interference screw fixation on both the femoral and tibial side and drilling the femoral tunnel(s) through the antero-medial portal in both groups. In the ADB group, the remnants of the ACL were identified and the grafts were placed anatomically. In the SB group, traditional placement of the graft was performed in a less anatomic manner. Pre-operatively, the groups were comparable in terms of age, gender, time between injury and operation and associated injuries. One independent physiotherapist performed all the pre-operative and post-operative assessments.

Results

The follow-up period was 26 (22–34) and 24 (23–30) months in the ADB and SB groups, respectively (p = 0.005). At follow-up, 78 % in the ADB group and 74 % in the SB group had a negative pivot-shift test (n.s.). The KT-1000 134N measurements were 2 (−5 to 10.5) and 2 (−4 to 7) mm in the ADB and SB groups, respectively (n.s.). At follow-up, the extension deficit was significantly larger in the ADB group than in the SB group (p = 0.001). The Tegner activity scale was significantly higher in the ADB group both pre-operatively and at follow-up (p = 0.03 and p = 0.004). In overall terms, both groups had improved significantly at the two-year follow-up.

Conclusion

In an unselected group of ACL-injured patients, anatomic double-bundle reconstruction did not result in better rotational or antero-posterior stability measurements than antero-medial portal non-anatomic single-bundle reconstruction at the two-year follow-up.

Level of evidence

III.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. 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 

  2. Ahldén M, Sernert N, Karlsson J, Kartus J (2013) A prospective randomized study comparing double- and single-bundle techniques for anterior cruciate ligament reconstruction. Am J Sports Med 41(11):2484–2491

    Article  PubMed  Google Scholar 

  3. Amis AA (2012) The functions of the fibre bundles of the anterior cruciate ligament in anterior drawer, rotational laxity and the pivot shift. Knee Surg Sports Traumatol Arthrosc 20(4):613–620

    Article  PubMed  Google Scholar 

  4. Andersson D, Samuelsson K, Karlsson J (2009) Treatment of anterior cruciate ligament injuries with special reference to surgical technique and rehabilitation: an assessment of randomized controlled trials. Arthroscopy 25(6):653–685

    Article  PubMed  Google Scholar 

  5. Ardern CL, Osterberg A, Tagesson S, Gauffin H, Webster KE, Kvist J (2014) The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction. Br J Sports Med 48(22):1613–1619

    Article  PubMed  Google Scholar 

  6. Ardern CL, Taylor NF, Feller JA, Webster KE (2014) Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med 48(21):1543–1552

    Article  PubMed  Google Scholar 

  7. Barenius B, Ponzer S, Shalabi A, Bujak R, Norlen L, Eriksson K (2014) Increased risk of osteoarthritis after anterior cruciate ligament reconstruction: a 14-year follow-up study of a randomized controlled trial. Am J Sports Med 42(5):1049–1057

    Article  PubMed  Google Scholar 

  8. Bedi A, Musahl V, Lane C, Citak M, Warren RF, Pearle AD (2010) Lateral compartment translation predicts the grade of pivot shift: a cadaveric and clinical analysis. Knee Surg Sports Traumatol Arthrosc 18(9):1269–1276

    Article  PubMed  Google Scholar 

  9. Beynnon BD, Johnson RJ, Naud S, Fleming BC, Abate JA, Brattbakk B, Nichols CE (2011) Accelerated versus nonaccelerated rehabilitation after anterior cruciate ligament reconstruction: a prospective, randomized, double-blind investigation evaluating knee joint laxity using roentgen stereophotogrammetric analysis. Am J Sports Med 39(12):2536–2548

    Article  PubMed  Google Scholar 

  10. Bjornsson H, Desai N, Musahl V, Alentorn-Geli E, Bhandari M, Fu F, Samuelsson K (2015) Is double-bundle anterior cruciate ligament reconstruction superior to single-bundle? A comprehensive systematic review. Knee Surg Sports Traumatol Arthrosc 23(3):696–739

    Article  PubMed  Google Scholar 

  11. Daniel DM, Stone ML, Sachs R, Malcom L (1985) Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption. Am J Sports Med 13(6):401–407

    CAS  Article  PubMed  Google Scholar 

  12. Desai N, Alentorn-Geli E, van Eck CF, Musahl V, Fu FH, Karlsson J, Samuelsson K (2016) A systematic review of single- versus double-bundle ACL reconstruction using the anatomic anterior cruciate ligament reconstruction scoring checklist. Knee Surg Sports Traumatol Arthrosc 24(3):862–872

    Article  PubMed  Google Scholar 

  13. Granan LP, Bahr R, Lie SA, Engebretsen L (2009) Timing of anterior cruciate ligament reconstructive surgery and risk of cartilage lesions and meniscal tears: a cohort study based on the Norwegian National Knee Ligament Registry. Am J Sports Med 37(5):955–961

    Article  PubMed  Google Scholar 

  14. Hefti F, Müller W, Jakob RP, Stäubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1(3–4):226–234

    CAS  Article  PubMed  Google Scholar 

  15. Hoshino Y, Araujo P, Ahlden M, Moore CG, Kuroda R, Zaffagnini S, Karlsson J, Fu FH, Musahl V (2012) Standardized pivot shift test improves measurement accuracy. Knee Surg Sports Traumatol Arthrosc 20(4):732–736

    Article  PubMed  Google Scholar 

  16. Hussein M, van Eck CF, Cretnik A, Dinevski D, Fu FH (2012) Prospective randomized clinical evaluation of conventional single-bundle, anatomic single-bundle, and anatomic double-bundle anterior cruciate ligament reconstruction: 281 cases with 3- to 5-year follow-up. Am J Sports Med 40(3):512–520

    Article  PubMed  Google Scholar 

  17. Jarvela T, Jarvela S (2013) Double-bundle versus single-bundle anterior cruciate ligament reconstruction. Clin Sports Med 32(1):81–91

    Article  PubMed  Google Scholar 

  18. Jarvela T, Moisala AS, Sihvonen R, Jarvela S, Kannus P, Jarvinen M (2008) Double-bundle anterior cruciate ligament reconstruction using hamstring autografts and bioabsorbable interference screw fixation: prospective, randomized, clinical study with 2-year results. Am J Sports Med 36(2):290–297

    Article  PubMed  Google Scholar 

  19. Karlsson J, Irrgang JJ, van Eck CF, Samuelsson K, Mejia HA, Fu FH (2011) Anatomic single-and double-bundle anterior cruciate ligament reconstruction, part 2 clinical application of surgical technique. Am J Sports Med 39(9):2016–2026

    Article  PubMed  Google Scholar 

  20. 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-A (9):1560–1572

  21. Koga H, Muneta T, Yagishita K, Watanabe T, Mochizuki T, Horie M, Nakamura T, Otabe K, Sekiya I (2015) Mid- to long-term results of single-bundle versus double-bundle anterior cruciate ligament reconstruction: randomized controlled trial. Arthroscopy 31(1):69–76

    Article  PubMed  Google Scholar 

  22. Kuroda R, Hoshino Y, Kubo S, Araki D, Oka S, Nagamune K, Kurosaka M (2012) Similarities and differences of diagnostic manual tests for anterior cruciate ligament insufficiency: a global survey and kinematics assessment. Am J Sports Med 40(1):91–99

    Article  PubMed  Google Scholar 

  23. Li X, Xu CP, Song JQ, Jiang N, Yu B (2013) Single-bundle versus double-bundle anterior cruciate ligament reconstruction: an up-to-date meta-analysis. Int Orthop 37(2):213–226

    Article  PubMed  Google Scholar 

  24. Li YL, Ning GZ, Wu Q, Wu QL, Li Y, Hao Y, Feng SQ (2014) Single-bundle or double-bundle for anterior cruciate ligament reconstruction: a meta-analysis. Knee 21(1):28–37

    Article  PubMed  Google Scholar 

  25. Mascarenhas R, Cvetanovich GL, Sayegh ET, Verma NN, Cole BJ, Bush-Joseph C, Bach BR Jr (2015) Does double-bundle anterior cruciate ligament reconstruction improve postoperative knee stability compared with single-bundle techniques? A systematic review of overlapping meta-analyses. Arthroscopy 31(6):1185–1196

    Article  PubMed  Google Scholar 

  26. Murawski CD, Wolf MR, Araki D, Muller B, Tashman S, Fu FH (2013) Anatomic anterior cruciate ligament reconstruction: current concepts and future perspective. Cartilage 4(3 Suppl):27S–37S

    Article  PubMed  PubMed Central  Google Scholar 

  27. Musahl V, Hoshino Y, Ahlden M, Araujo P, Irrgang JJ, Zaffagnini S, Karlsson J, Fu FH (2012) The pivot shift: a global user guide. Knee Surg Sports Traumatol Arthrosc 20(4):724–731

    Article  PubMed  Google Scholar 

  28. Paxton ES, Kymes SM, Brophy RH (2010) Cost-effectiveness of anterior cruciate ligament reconstruction: a preliminary comparison of single-bundle and double-bundle techniques. Am J Sports Med 38(12):2417–2425

    Article  PubMed  Google Scholar 

  29. Roos EM, Roos HP, Ekdahl C, Lohmander LS (1998) Knee injury and Osteoarthritis Outcome Score (KOOS)—validation of a Swedish version. Scand J Med Sci Sports 8(6):439–448

    CAS  Article  PubMed  Google Scholar 

  30. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 28(2):88–96

    CAS  Article  PubMed  Google Scholar 

  31. 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 

  32. Siebold R, Branch TP, Freedberg HI, Jacobs CA (2011) A matched pairs comparison of single- versus double-bundle anterior cruciate ligament reconstructions, clinical results and manual laxity testing. Knee Surg Sports Traumatol Arthrosc 19(Suppl 1):S4–S11

    Article  PubMed  Google Scholar 

  33. 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 

  34. Siebold R, Schuhmacher P, Fernandez F, Smigielski R, Fink C, Brehmer A, Kirsch J (2015) Flat midsubstance of the anterior cruciate ligament with tibial “C”-shaped insertion site. Knee Surg Sports Traumatol Arthrosc 23(11):3136–3142

    Article  PubMed  Google Scholar 

  35. Smigielski R, Zdanowicz U, Drwiega M, Ciszek B, Ciszkowska-Lyson B, Siebold R (2015) Ribbon like appearance of the midsubstance fibres of the anterior cruciate ligament close to its femoral insertion site: a cadaveric study including 111 knees. Knee Surg Sports Traumatol Arthrosc 23(11):3143–3150

    Article  PubMed  Google Scholar 

  36. Streich NA, Friedrich K, Gotterbarm T, Schmitt H (2008) Reconstruction of the ACL with a semitendinosus tendon graft: a prospective randomized single blinded comparison of double-bundle versus single-bundle technique in male athletes. Knee Surg Sports Traumatol Arthrosc 16(3):232–238

    Article  PubMed  Google Scholar 

  37. Suomalainen P, Jarvela T, Paakkala A, Kannus P, Jarvinen M (2012) Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective randomized study with 5-year results. Am J Sports Med 40(7):1511–1518

    Article  PubMed  Google Scholar 

  38. The Swedish National Knee Ligament Register (2014) Swedish ACL Register: annual report 2014. http://www.artroclinic.se/info/rapport2014en.pdf

  39. Tegner Y, Lysholm J, Lysholm M, Gillquist J (1985) Rating systems in evaluation of knee ligament injuries. ClinOrthopRelat Res 198:43–49

    Google Scholar 

  40. Tegner Y, Lysholm J, Lysholm M, Gillquist J (1986) A performance test to monitor rehabilitation and evaluate anterior cruciate ligament injuries. Am J Sports Med 14(2):156–159

    CAS  Article  PubMed  Google Scholar 

  41. 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(3):405–424

    Article  PubMed  Google Scholar 

  42. Wright RW, Fetzer GB (2007) Bracing after ACL reconstruction: a systematic review. Clin Orthop Relat Res 455:162–168

    Article  PubMed  Google Scholar 

  43. Xu Y, Ao YF, Wang JQ, Cui GQ (2014) Prospective randomized comparison of anatomic single- and double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 22(2):308–316

    Article  PubMed  Google Scholar 

  44. Yagi M, Kuroda R, Nagamune K, Yoshiya S, Kurosaka M (2007) Double-bundle ACL reconstruction can improve rotational stability. Clin Orthop Relat Res 454:100–107

    Article  PubMed  Google Scholar 

  45. 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(3):240–251

    Article  PubMed  Google Scholar 

  46. Yasuda K, van Eck CF, Hoshino Y, Fu FH, Tashman S (2011) Anatomic single-and double-bundle anterior cruciate ligament reconstruction, part 1 basic science. Am J Sports Med 39(8):1789–1799

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Orthopaedics, NU Hospital Group, 451 80, Uddevalla, Trollhättan, Sweden

    Ioannis Karikis, Abraham Casut & Jüri Kartus

  2. Ortho Center, IFK Clinic, Gothenburg, Sweden

    Mattias Ahldén

  3. Department of Research and Development, NU Hospital Group, Trollhättan, Sweden

    Ninni Sernert & Jüri Kartus

  4. Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Ioannis Karikis, Mattias Ahldén, Ninni Sernert & Jüri Kartus

Authors
  1. Ioannis Karikis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mattias Ahldén
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Abraham Casut
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ninni Sernert
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jüri Kartus
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ioannis Karikis.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Karikis, I., Ahldén, M., Casut, A. et al. Comparison of outcome after anatomic double-bundle and antero-medial portal non-anatomic single-bundle reconstruction in ACL-injured patients. Knee Surg Sports Traumatol Arthrosc 25, 1307–1315 (2017). https://doi.org/10.1007/s00167-016-4132-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-016-4132-z

Keywords

  • Anterior cruciate ligament
  • Reconstruction
  • Hamstrings tendon
  • Double bundle
  • Non-anatomic single bundle
  • Outcome