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Double Bundle versus Single Bundle Reconstruction in the Treatment of Posterior Cruciate Ligament Injury: A Prospective Comparative Study

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Abstract

Background

The debate continues regarding the best way to reconstruct posterior cruciate ligament (PCL). The objective of this study was to compare the knee stability and clinical outcomes after single and double bundle (SB and DB) PCL reconstruction.

Materials and Methods

A total of 98 patients with PCL injury were enrolled for PCL reconstruction with four-strand semitendinosus and gracilis tendon autograft in the SB technique (n = 65) or two-strand Achilles allograft in the DB technique (n = 33). Each bundle fixation was achieved by the means of femoral Endo Button CL and tibial bioabsorbable interference screw. Demographic data, knee stability, and clinical outcomes were collected for analysis.

Results

The SB and DB groups showed comparable demographic data. After a minimum followup interval of 24 months, the data of 59 patients in the SB group and 30 patients in the DB group were analyzed. There was no statistical difference between the SB and DB group in terms of both knee stability and clinical outcomes (P > 0.05).

Conclusions

Compared with the SB technique, the DB technique did not exhibit any superiority in knee stability or clinical outcomes.

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References

  1. Butler DL, Noyes FR, Grood ES. Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. J Bone Joint Surg Am 1980;62:259–70.

    Article  CAS  PubMed  Google Scholar 

  2. Kennedy JC, Hawkins RJ, Willis RB, Danylchuck KD. Tension studies of human knee ligaments. Yield point, ultimate failure, and disruption of the cruciate and tibial collateral ligaments. J Bone Joint Surg Am 1976;58:350–5.

    Article  CAS  PubMed  Google Scholar 

  3. Trent PS, Walker PS, Wolf B. Ligament length patterns, strength, and rotational axes of the knee joint. Clin Orthop Relat Res 1976;117:263–70.

    Google Scholar 

  4. Girgis FG, Marshall JL, Monajem A. The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop Relat Res 1975;Jan-Feb (106):216–31.

  5. Race A, Amis AA. The mechanical properties of the two bundles of the human posterior cruciate ligament. J Biomech 1994;27:13–24.

    Article  CAS  PubMed  Google Scholar 

  6. Harner CD, Janaushek MA, Kanamori A, Yagi M, Vogrin TM, Woo SL, et al. Biomechanical analysis of a double-bundle posterior cruciate ligament reconstruction. Am J Sports Med 2000;28:144–51.

    Article  CAS  PubMed  Google Scholar 

  7. Liu P, Ao YF. The clinical anatomical research of the tibial attachment of the posterior cruciate ligament and the tibial tunnel position in double-bundle posterior cruciate ligament reconstruction. Zhonghua Wai Ke Za Zhi 2008;46:1080–4.

    PubMed  Google Scholar 

  8. Markolf KL, Slauterbeck JR, Armstrong KL, Shapiro MS, Finerman GA. A biomechanical study of replacement of the posterior cruciate ligament with a graf. Part 1: Isometry, pre-tension of the graft, and anterior-posterior laxity. J Bone Joint Surg Am 1997;79:375–80.

    Article  CAS  PubMed  Google Scholar 

  9. Wang CJ, Chen HS, Huang TW. Outcome of arthroscopic single bundle reconstruction for complete posterior cruciate ligament tear. Injury 2003;34:747–51.

    Article  PubMed  Google Scholar 

  10. Race A, Amis AA. PCL reconstruction. In vitro biomechanical comparison of ‘isometric’ versus single and double-bundled ‘anatomic’ grafts. J Bone Joint Surg Br 1998;80:173–9.

    Article  CAS  PubMed  Google Scholar 

  11. Li Y, Li J, Wang J, Gao S, Zhang Y. Comparison of single-bundle and double-bundle isolated posterior cruciate ligament reconstruction with allograft: A prospective, randomized study. Arthroscopy 2014;30:695–700.

    Article  CAS  PubMed  Google Scholar 

  12. Hatayama K, Higuchi H, Kimura M, Kobayashi Y, Asagumo H, Takagishi K, et al. A comparison of arthroscopic single- and double-bundle posterior cruciate ligament reconstruction: Review of 20 cases. Am J Orthop (Belle Mead NJ) 2006;35:568–71.

    Google Scholar 

  13. Wang CJ, Weng LH, Hsu CC, Chan YS. Arthroscopic single- versus double-bundle posterior cruciate ligament reconstructions using hamstring autograft. Injury 2004;35:1293–9.

    Article  PubMed  Google Scholar 

  14. Xu Y, Yin Y, Wang JQ, Ao YF. Comparison of single and double bundle isolate posterior cruciate ligament reconstruction with hamstring autograft. Zhonghua Wai Ke Za Zhi 2013;51:247–51.

    PubMed  Google Scholar 

  15. Kim SJ, Kim SH, Kim SG, Kung YP. Comparison of the clinical results of three posterior cruciate ligament reconstruction techniques: Surgical technique. J Bone Joint Surg Am 2010;92 Suppl 1 (Pt 2):145–57.

    Article  PubMed  Google Scholar 

  16. Kim SJ, Kim TE, Jo SB, Kung YP. Comparison of the clinical results of three posterior cruciate ligament reconstruction techniques. J Bone Joint Surg Am 2009;91:2543–9.

    Article  PubMed  Google Scholar 

  17. Yoon KH, Bae DK, Song SJ, Cho HJ, Lee JH. A prospective randomized study comparing arthroscopic single-bundle and double-bundle posterior cruciate ligament reconstructions preserving remnant fibers. Am J Sports Med 2011;39:474–80.

    Article  PubMed  Google Scholar 

  18. Valdevit A, Kambic H, Lilly D, Graham S, Parker R, Bergfeld J, et al. Non-linear fitting of mechanical data for efficacy determination of single versus double bundle achilles tendon grafts for PCL reconstructions. Biomed Mater Eng 2002;12:309–17.

    CAS  PubMed  Google Scholar 

  19. Kim SJ, Jung M, Moon HK, Kim SG, Chun YM. Anterolateral transtibial posterior cruciate ligament reconstruction combined with anatomical reconstruction of posterolateral corner insufficiency: Comparison of single-bundle versus double-bundle posterior cruciate ligament reconstruction over a 2- to 6-year followup. Am J Sports Med 2011;39:481–9.

    Article  PubMed  Google Scholar 

  20. Takeda Y, Sato R, Ogawa T, Fujii K, Naruse A. In vivo magnetic resonance imaging measurement of tibiofemoral relation with different knee flexion angles after single- and double-bundle anterior cruciate ligament reconstructions. Arthroscopy 2009;25:733–41.

    Article  PubMed  Google Scholar 

  21. Margheritini F, Mariani PF, Mariani PP. Current concepts in diagnosis and treatment of posterior cruciate ligament injury. Acta Orthop Belg 2000;66:217–28.

    CAS  PubMed  Google Scholar 

  22. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957;16:494–502.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Stähelin AC, Südkamp NP, Weiler A. Anatomic double-bundle posterior cruciate ligament reconstruction using hamstring tendons. Arthroscopy 2001;17:88–97.

    Article  PubMed  Google Scholar 

  24. Ao YF. Repair or reconstruction of posterior cruciate ligament injury. Cruciate Ligament Surgery. Beijing: Peking University Medical Press; 2009. p. 326.

    Google Scholar 

  25. Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 1990;13:227–36.

    Article  CAS  PubMed  Google Scholar 

  26. Larson DE, Premer RF, Gustilo RB. Acute ligamentous injuries of the knee joint. Minn Med 1973;56:374–6.

    CAS  PubMed  Google Scholar 

  27. Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985;198:43–9.

    Google Scholar 

  28. Makris CA, Georgoulis AD, Papageorgiou CD, Moebius UG, Soucacos PN. Posterior cruciate ligament architecture: Evaluation under microsurgical dissection. Arthroscopy 2000;16:627–32.

    Article  CAS  PubMed  Google Scholar 

  29. Inderster A, Benedetto KP, Klestil T, Künzel KH, Gaber O. Fiber orientation of posterior cruciate ligament: An experimental morphological and functional study, part 2. Clin Anat 1995;8:315–22.

    Article  CAS  PubMed  Google Scholar 

  30. Harner CD, Xerogeanes JW, Livesay GA, Carlin GJ, Smith BA, Kusayama T, et al. The human posterior cruciate ligament complex: An interdisciplinary study. Ligament morphology and biomechanical evaluation. Am J Sports Med 1995;23:736–45.

    Article  CAS  PubMed  Google Scholar 

  31. Oakes DA, Markolf KL, McWilliams J, Young CR, McAllister DR. The effect of femoral tunnel position on graft forces during inlay posterior cruciate ligament reconstruction. Am J Sports Med 2003;31:667–72.

    Article  PubMed  Google Scholar 

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Correspondence to Zhenhua Ma.

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Xu, M., Zhang, Q., Dai, S. et al. Double Bundle versus Single Bundle Reconstruction in the Treatment of Posterior Cruciate Ligament Injury: A Prospective Comparative Study. JOIO 53, 297–303 (2019). https://doi.org/10.4103/ortho.IJOrtho_430_17

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