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Anatomic double-bundle and over-the-top single-bundle with additional extra-articular tenodesis: an in vivo quantitative assessment of knee laxity in two different ACL reconstructions

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

Abstract

Purpose

Combinations of intra- and extra-articular procedures have been proposed for anterior cruciate ligament reconstruction with the aim of achieving an optimal control of translational and rotational knee laxities. Recently, the need for better reproducing the structural and functional behavior of the native anterior cruciate ligament led to the definition of anatomic double-bundle surgical approach. This study aimed to quantitatively verify whether the in vivo static and dynamic behavior obtained using over-the-top single-bundle with extra-articular tenodesis reconstruction was comparable to the results achieved by anatomic double-bundle approach.

Methods

Thirty-five consecutive patients, with an isolated anterior cruciate ligament injury, were included in the study. Standard clinical laxities and pivot-shift test were quantified before and after anterior cruciate ligament reconstruction by means of a surgical navigation system dedicated to kinematic assessment; displacements of medial and lateral compartment during stress tests were also analyzed.

Results

Single-bundle with extra-articular tenodesis approach presented statistically better laxity reduction in varus/valgus stress test at full extension and in internal/external rotation at 90° of flexion; lateral plasty controlled better the lateral compartment during drawer test and varus/valgus stress test both at 0° and 30° of flexion and both the compartments during internal/external rotation at 90° of flexion. On the other hand, pivot-shift phenomenon was better controlled by anatomic double-bundle reconstruction.

Conclusions

Both the reconstructions worked similarly for static knee laxity. The extra-articular procedure played an important role in better constraining the displacement of lateral tibial compartment, whereas the anatomic double-bundle reconstruction better restored the dynamic behavior of knee joint highlighted under pivot-shift stress test.

Study design

Case series.

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Acknowledgments

The authors would like to thank all the nurses and staff at Istituto Ortopedico Rizzoli (Bologna, Italy) and also all the people at Laboratorio di Biomeccanica ed Innovazione Tecnologica (Bologna, Italy)—in particular Mr. Emil Ferretti for his great contribution in the management of our technological equipment.

Conflict of interest

The authors certify that the above-named manuscript describes our own original work on properly conducted and documented research and that all authors contributed to the conception and design of the study or acquisition of data, analysis and interpretation of data, and revising the final version of the article. All authors believe that the manuscript represents honest work. This paper has not been submitted to, or published by, any other journal, nor will it be submitted to any other journal without prior written notification to the Editor in Chief that the manuscript is to be withdrawn.

The authors declare that there was neither financial nor personal relationship including employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registration, and grants with other people or organization that could inappropriately influence (bias) their work.

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Authors and Affiliations

  1. Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy

    S. Zaffagnini, C. Signorelli, N. Lopomo, T. Bonanzinga, G. M. Marcheggiani Muccioli, S. Bignozzi, A. Visani & M. Marcacci

  2. Laboratorio di NanoBiotecnologie, NaBi, Istituto Ortopedico Rizzoli, Bologna, Italy

    N. Lopomo

  3. Dipartimento di Bioingegneria, Politecnico di Milano, Milan, Italy

    C. Signorelli

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  1. S. Zaffagnini
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  2. C. Signorelli
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  3. N. Lopomo
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  4. T. Bonanzinga
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  5. G. M. Marcheggiani Muccioli
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  6. S. Bignozzi
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  7. A. Visani
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  8. M. Marcacci
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Correspondence to N. Lopomo.

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Zaffagnini, S., Signorelli, C., Lopomo, N. et al. Anatomic double-bundle and over-the-top single-bundle with additional extra-articular tenodesis: an in vivo quantitative assessment of knee laxity in two different ACL reconstructions. Knee Surg Sports Traumatol Arthrosc 20, 153–159 (2012). https://doi.org/10.1007/s00167-011-1589-7

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  • DOI: https://doi.org/10.1007/s00167-011-1589-7

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