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Femoral bridge stability in double-bundle ACL reconstruction: impact of bridge width and different fixation techniques on the structural properties of the graft/femur complex

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

The aim of this study was to evaluate the impact of different widths of the bony bridge between the femoral AM and PL bundle tunnel and different fixation techniques on the structural properties of the graft/femur complex in double-bundle ACL reconstructions.

Hypothesis

Double-bundle ACL reconstruction with a bony bridge between AM and PL bundle tunnel of 1 mm results in significantly lower structural properties of the graft/femur complex when compared to a bridge of 2 and 3 mm. Interference screw fixation significantly lowers the structural properties when compared to cortical fixation.

Study design

Controlled laboratory study.

Methods

Double-bundle ACL reconstructions using different bridge widths (1 mm, 2 mm, and 3 mm bridge) were loaded to failure after a cyclic loading protocol (1,000 cycles 0–200 N) and the structural properties were compared to a single-bundle ACL reconstruction group (n = 10 in each group). The structural properties of using a cortical button fixation were then compared to interference screw fixation (2 mm bridge). Statistical analyses were performed using a Mann–Whitney test (P < 0.05).

Results

Double-bundle reconstructions with cortical button fixation (1, 2, and 3 mm bridge) showed significantly higher ultimate failure loads and stiffness and significantly lower elongation compared to single-bundle reconstructions. Double-bundle ACL reconstructions with a 1 mm bridge showed significantly reduced structural properties of the graft/femur complex compared to a 2 or 3 mm bridge. Aperture fixation led to significantly lower ultimate loads when compared to cortical fixation.

Conclusion

The bony bridge between the two femoral tunnels in double-bundle ACL reconstructions influences the stability of the graft/femur complex. Aperture fixation using interference screws shows inferior results when compared to cortical fixation.

Clinical relevance

The results suggest that the indication for anatomical ACL reconstruction may include the size of the lateral femoral condyle. In small knees, a second femoral tunnel may be difficult to locate with a minimum bridge width of 2 mm.

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References

  1. Aglietti P, Giron F, Cuomo P, Losco M, Mondanelli N (2007) Single and double-incision double-bundle ACL reconstruction. Clin Orthop Relat Res 454:108–113

    Article  PubMed  Google Scholar 

  2. Beynnon BD, Johnson RJ, Abate JA, Fleming BC, Nichols CE (2005) Treatment of anterior cruciate ligament injuries, part I. Am J Sports Med 33(10):1579–1602

    Article  PubMed  Google Scholar 

  3. Brucker PU, Lorenz S, Imhoff AB (2006) Aperture fixation in arthroscopic anterior cruciate ligament double-bundle reconstruction. Arthroscopy 22(11):1250–1256

    PubMed  Google Scholar 

  4. Butler DL (1989) Kappa delta award paper. Anterior cruciate ligament: its normal response and replacement. J Orthop Res 7(6):910–921

    Article  PubMed  CAS  Google Scholar 

  5. Chhabra A, Starman JS, Ferretti M, Vidal AF, Zantop T, Fu FH (2006) Anatomic, radiographic, biomechanical, and kinematic evaluation of the anterior cruciate ligament and its two functional bundles. J Bone Joint Surg Am 88:2–10

    Article  PubMed  Google Scholar 

  6. Dandy DJ (1981) Arthroscopic surgery of the knee. Churchill Livingstone, Edinburgh London New York, pp 67–68

    Google Scholar 

  7. Girgis FG, Marshall JL, Monajem A (1975) The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop 106:216–231

    Article  PubMed  Google Scholar 

  8. Harner CD, Poehling GG (2004) Double bundle or double trouble? Arthroscopy 20(10):1013–1014

    PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  10. Mithoefer K, Gill TJ, Vrahas MS (2005) Supracondylar femoral fracture after arthroscopic reconstruction of the anterior cruciate ligament. A case report. J Bone Joint Surg Am 87:1591–1596

    Article  PubMed  Google Scholar 

  11. Nagarkatti DG, McKeon BP, Donahue BS (2001) Mechanical evaluation of a soft tissue interference screw in free tendon anterior cruciate ligament graft fixation. Am J Sports Med 29:67–71

    PubMed  CAS  Google Scholar 

  12. Palmer I (1938) On the injuries of the ligaments of the knee joint: a clinical study. Acta chirur scand 91:1–282

    Google Scholar 

  13. Petersen W, Tillmann B (2002) Anatomy and function of the anterior cruciate ligament. Orthopäde 31:710–718

    Article  PubMed  CAS  Google Scholar 

  14. Petersen W, Tretow H, Weimann A, Herbort M, Fu FH, Raschke M, Zantop T (2007) Biomechanical evaluation of two techniques for double-bundle anterior cruciate ligament reconstruction: one tibial tunnel versus two tibial tunnels. Am J Sports Med 35:228–234

    Article  PubMed  Google Scholar 

  15. Petersen W, Zantop T (2007) Clinical anatomy of the ACL with regard to its two bundles. Clin Orthop Relat Res 454:35–47

    Article  PubMed  Google Scholar 

  16. Siebold R (2007) Observations on bone tunnel enlargement after double-bundle anterior cruciate ligament reconstruction. Arthroscopy 23(3):291–298

    PubMed  Google Scholar 

  17. Singhatat W, Lawhorn KW, Howell SM, Hull ML (2002) How four weeks of implantation affect the strength and stiffness of a tendon graft in a bone tunnel: a study of two fixation devices in an extraarticular model in ovine. Am J Sports Med 30(4):506–513

    PubMed  Google Scholar 

  18. Weiler A, Hoffmann RFG, Bail HJ, Rehm O, Südkamp NP (2002) Tendon healing in a bone tunnel. Part II: histologic analysis after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep. Arthroscopy 18(2):124–135

    Article  PubMed  Google Scholar 

  19. Xerogeanes JW, Fox RJ, Takeda Y, Kim HS, Ishibashi Y, Carlin GJ, Woo SL (1998) A functional comparison of animal anterior cruciate ligament models to the human anterior cruciate ligament. An Biomed Eng 26:345–352

    Article  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  21. Yagi M, Wong EK, Kanamori A, Debski RE, Fu FH, Woo SL (2002) Biomechanical analysis of an anterior cruciate ligament reconstruction. Am J Sports Med 30(5):660–666

    PubMed  Google Scholar 

  22. 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

    PubMed  Google Scholar 

  23. 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(2):223–227

    Article  PubMed  Google Scholar 

  24. Zantop T, Kubo S, Petersen W, Musahl V, Fu FH (2007) Current techniques in anatomic anterior cruciate ligament reconstruction. Arthroscopy 23(9):938–947

    Article  PubMed  Google Scholar 

  25. Zantop T, Weimann A, Wolle K, Musahl V, Langer M, Petersen W (2007) Initial and 6 weeks postoperative structural properties of soft tissue anterior cruciate ligament reconstruction with cross-pin or interference screw fixation: an in vivo study in sheep. Arthroscopy 23(1):14–20

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Trauma-, Hand-, and Reconstructive Surgery, Westfälische Wilhelms-Universität Münster, Waldeyerstr, 1, D-48149, Münster, Germany

    Ann-Kristin Lehmann, Thore Zantop & Michael J. Raschke

  2. Department of Medical Informatics and Biomathematics, Westfälische Wilhelms-Universität Münster, Münster, Germany

    Nani Osada

  3. Department of Trauma Surgery, Martin Luther Hospital, Berlin, Germany

    Wolf Petersen

Authors
  1. Ann-Kristin Lehmann
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  2. Nani Osada
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  3. Thore Zantop
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  4. Michael J. Raschke
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  5. Wolf Petersen
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Corresponding author

Correspondence to Thore Zantop.

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Lehmann, AK., Osada, N., Zantop, T. et al. Femoral bridge stability in double-bundle ACL reconstruction: impact of bridge width and different fixation techniques on the structural properties of the graft/femur complex. Arch Orthop Trauma Surg 129, 1127–1132 (2009). https://doi.org/10.1007/s00402-009-0869-x

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  • DOI: https://doi.org/10.1007/s00402-009-0869-x

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