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Comparison of anterior and rotatory laxity using navigation between single- and double-bundle ACL reconstruction: prospective randomized trial

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

Abstract

Purpose

To prospectively assess the anterior tibial translation and rotational kinematics of the knee joint as well as the clinical outcome after single-bundle (SB) and double-bundle (DB) anterior cruciate ligament (ACL) reconstruction.

Methods

Forty-two patients randomly underwent single-bundle (Group SB, n = 21) or double-bundle (Group DB, n = 21) ACL reconstruction using hamstring tendon autografts. Anterior tibial translation and rotatory laxity were measured prior to and after fixation of the graft during reconstruction under the guidance of a navigation system. Clinical outcome measurements included the evaluation of the joint stability and functional status.

Results

Anterior tibial translation and rotatory laxity were improved significantly at all degrees of knee flexion in both groups. The postoperative total rotation (sum of internal and external rotation) at 30° and 60° (26.6° vs. 24.0°; 28.7° vs. 25.1°) as well as postoperative change in external rotation at 60° (−1.4° vs. −4.6°), and a change in total rotation at 30° and 60° (−7.0° vs. −11.5°; −6.1° vs. −8.9°) differed between the two groups, with better stability in the DB group. At 2 years follow-up, IKDC subjective satisfaction score was significantly different between two groups (70.9 vs. 79.6), while manual and instrumented laxity, pivot shift tests, modified Lysholm score, Tegner activity score, thigh muscle strengths were not different. Correlation analysis showed little correlations between anterior laxity tests at follow-up, and the kinematic variables measured by navigation during surgery while pivot shift test, IKDC subjective satisfaction score, modified Lysholm score, and Tegner activity score were mainly correlated with navigation-measured rotations in both groups.

Conclusions

The kinematic tests in this study found evidence suggesting that the DB ACL reconstruction improved rotatory laxity better than the SB ACL reconstruction at 30° and 60° of flexion, but there was no difference in functional outcome at 2 years follow-up between SB and DB groups.

Level of evidence

Prospective comparative study, Level II.

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References

  1. Adachi N, Ochi M, Uchio Y, Iwasa J, Kuriwaka M, Ito Y (2004) Reconstruction of the anterior cruciate ligament. Single- versus double-bundle multistranded hamstring tendons. J Bone Joint Surg Br 86:515–520

    PubMed  CAS  Google Scholar 

  2. Aglietti P, Buzzi R, D’Andria S, Zaccherotti G (1992) Arthroscopic anterior cruciate ligament reconstruction with patellar tendon. Arthroscopy 8:510–516

    Article  PubMed  CAS  Google Scholar 

  3. 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 38:25–34

    Article  PubMed  Google Scholar 

  4. Bach JM, Hull ML, Patterson HA (1997) Direct measurement of strain in the posterolateral bundle of the anterior cruciate ligament. J Biomech 30:281–283

    Article  PubMed  CAS  Google Scholar 

  5. 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 18:1269–1276

    Article  PubMed  Google Scholar 

  6. Bignozzi S, Zaffagnini S, Lopomo N, Fu FH, Irrgang JJ, Marcacci M (2010) Clinical relevance of static and dynamic tests after anatomical double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 18:37–42

    Article  PubMed  Google Scholar 

  7. Bull AM, Andersen HN, Basso O, Targett J, Amis AA (1999) Incidence and mechanism of the pivot shift. An in vitro study. Clin Orthop Relat Res 363:219–231

    Article  PubMed  Google Scholar 

  8. Bull AM, Earnshaw PH, Katchburian MV, Hassan AN, Amis AA (2002) Intraoperative measurement of knee kinematics in reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 84:1075–1081

    Article  PubMed  CAS  Google Scholar 

  9. Chouliaras V, Ristanis S, Moraiti C, Stergiou N, Georgoulis AD (2007) Effectiveness of reconstruction of the anterior cruciate ligament with quadrupled hamstrings and bone-patellar tendon-bone autografts: an in vivo study comparing tibial internal-external rotation. Am J Sports Med 35:189–196

    Article  PubMed  Google Scholar 

  10. Colombet P, Robinson J, Christel P, Franceschi J-P, Djian P (2007) Using navigation to measure rotation kinematics during ACL reconstruction. Clin Orthop Relat Res 454:59–65

    Article  PubMed  Google Scholar 

  11. Ferretti A, Monaco E, Labianca L, de Carli A, Maestri B, Conteduca F (2009) Double-bundle anterior cruciate ligament reconstruction: a comprehensive kinematic study using navigation. Am J Sports Med 37:1548–1553

    Article  PubMed  Google Scholar 

  12. Gobbi A, Mahajan V, Karnatzikos G, Nakamura N (2011) Single- versus double-bundle ACL reconstruction: is there any difference in stability and function at 3-year followup? Clin Orthop Relat Res. Epub doi:10.1007/s11999-011-1940-9

  13. Hamada M, Shino K, Horibe S, Mitsuoka T, Miyama T, Shiozaki Y, Mae T (2001) Single- versus bi-socket anterior cruciate ligament reconstruction using autogenous multiple-stranded hamstring tendons with endobutton femoral fixation: a prospective study. Arthroscopy 17:801–807

    PubMed  CAS  Google Scholar 

  14. Harner CD, Honkamp NJ, Ranawat AS (2008) Anteromedial portal technique for creating the anterior cruciate ligament femoral tunnel. Arthroscopy 24:113–115

    Article  PubMed  Google Scholar 

  15. Hart R, Krejzla J, Sváb P, Kocis J, Stipcák V (2008) Outcomes after conventional versus computer-navigated anterior cruciate ligament reconstruction. Arthroscopy 24:569–578

    Article  PubMed  Google Scholar 

  16. Ishibashi Y, Tsuda E, Tazawa K, Sato H, Toh S (2005) Intraoperative evaluation of the anatomical double-bundle anterior cruciate ligament reconstruction with the orthopilot navigation system. Orthopedics 28:s1277–s1282

    PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  18. Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ (2004) Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction. Am J Sports Med 32:629–634

    Article  PubMed  Google Scholar 

  19. Koh J (2005) Computer-assisted navigation and anterior cruciate ligament reconstruction: accuracy and outcomes. Orthopedics 28:s1283–s1287

    PubMed  Google Scholar 

  20. Koh J, Koo SS, Leonard J, Kodali P (2006) Anterior cruciate ligament (ACL) tunnel placement: a radiographic comparison between navigated versus manual ACL reconstruction. Orthopedics 29:S122–S124

    PubMed  Google Scholar 

  21. Lewis PB, Parameswaran AD, Rue JP, Bach BRJ (2008) Systematic review of single-bundle anterior cruciate ligament reconstruction outcomes: a baseline assessment for consideration of double-bundle techniques. Am J Sports Med 36:2028–2036

    Article  PubMed  Google Scholar 

  22. Longo UG, King JB, Denaro V, Maffulli N (2008) Double-bundle arthroscopic reconstruction of the anterior cruciate ligament: does the evidence add up? J Bone Joint Surg Br 90:995–999

    Article  PubMed  CAS  Google Scholar 

  23. Lopomo N, Bignozzi S, Martelli S, Zaffagnini S, Iacono F, Visani A, Marcacci M (2009) Reliability of a navigation system for intra-operative evaluation of antero-posterior knee joint laxity. Comput Biol Med 39:280–285

    Article  PubMed  Google Scholar 

  24. Lopomo N, Zaffagnini S, Bignozzi S, Visani A, Marcacci M (2010) Pivot-shift test: analysis and quantification of knee laxity parameters using a navigation system. J Orthop Res 28:164–169

    PubMed  Google Scholar 

  25. Lubowitz JH (2009) Anteromedial portal technique for the anterior cruciate ligament femoral socket: pitfalls and solutions. Arthroscopy 25:95–101

    Article  PubMed  Google Scholar 

  26. Mae T, Shino K, Miyama T, Shinjo H, Yoshikawa H, Fujie H (2001) Single- versus two-femoral socket anterior cruciate ligament reconstruction technique: biomechanical analysis using a robotic simulator. Arthroscopy 17:708–716

    Article  PubMed  CAS  Google Scholar 

  27. Markolf KL, Park S, Jackson SR, McAllister DR (2009) Anterior-posterior and rotatory stability of single and double-bundle anterior cruciate ligament reconstructions. J Bone Joint Surg Am 91:107–118

    Article  PubMed  Google Scholar 

  28. Matsumoto H (1990) Mechanism of the pivot shift. J Bone Joint Surg Br 72:816–821

    PubMed  CAS  Google Scholar 

  29. Muneta T, Sekiya I, Yagishita K, Ogiuchi T, Yamamoto H, Shinomiya K (1999) Two-bundle reconstruction of the anterior cruciate ligament using semitendinosus tendon with endobuttons: operative technique and preliminary results. Arthroscopy 15:618–624

    Article  PubMed  CAS  Google Scholar 

  30. Noyes FR, Grood ES, Cummings JF, Wroble RR (1991) An analysis of the pivot shift phenomenon. The knee motions and subluxations induced by different examiners. Am J Sports Med 19:148–155

    Article  PubMed  CAS  Google Scholar 

  31. Plaweski S, Cazal J, Rosell P, Merloz P (2006) Anterior cruciate ligament reconstruction using navigation: a comparative study on 60 patients. Am J Sports Med 34:542–552

    Article  PubMed  Google Scholar 

  32. Radford WJ, Amis AA (1990) Biomechanics of a double prosthetic ligament in the anterior cruciate deficient knee. J Bone Joint Surg Br 72:1038–1043

    PubMed  CAS  Google Scholar 

  33. Ristanis S, Stergiou N, Patras K, Tsepis E, Moraiti C, Georgoulis AD (2006) Follow-up evaluation 2 years after ACL reconstruction with bone-patellar tendon-bone graft shows that excessive tibial rotation persists. Clin J Sport Med 16:111–116

    Article  PubMed  Google Scholar 

  34. Robinson J, Carrat L, Granchi C, Colombet P (2007) Influence of anterior cruciate ligament bundles on knee kinematics: clinical assessment using computer-assisted navigation. Am J Sports Med 35:2006–2013

    Article  PubMed  Google Scholar 

  35. Seon JK, Park SJ, Lee KB, Yoon TR, Kozanek M, Song EK (2009) Range of motion in total knee arthroplasty: a prospective comparison of high-flexion and standard cruciate-retaining designs. J Bone Joint Surg Am 91:672–679

    Article  PubMed  Google Scholar 

  36. Siebold R, Dehler C, Ellert T (2008) Prospective randomized comparison of double-bundle versus single-bundle anterior cruciate ligament reconstruction. Arthroscopy 24:137–145

    Article  PubMed  Google Scholar 

  37. Snyder-Mackler L, Fitzgerald GK, Bartolozzi AR, Ciccotti MG (1997) The relationship between passive joint laxity and functional outcome after anterior cruciate ligament injury. Am J Sports Med 25:191–195

    Article  PubMed  CAS  Google Scholar 

  38. Song EK, Oh LS, Gill TJ, Gadikota HR, Seon JK (2009) Prospective comparative study of anterior cruciate ligament reconstruction using the double-bundle and single-bundle techniques. Am J Sports Med 37:1705–1711

    Article  PubMed  Google Scholar 

  39. Tsuda E, Ishibashi Y, Fukuda A, Tsukada H, Toh S (2007) Validation of computer-assisted double-bundle anterior cruciate ligament reconstruction. Orthopedics 30:S136–S140

    PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  42. Yasuda K, Kondo E, Ichiyama H, Kitamura N, Tanabe Y, Tohyama H, Minami A (2004) Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts. Arthroscopy 20:1015–1025

    Article  PubMed  Google Scholar 

  43. 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

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was supported by a grant of the Korean Health Technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea. (A100451).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110744, Korea

    Sahnghoon Lee, Hyoungmin Kim, Jak Jang, Sang Cheol Seong & Myung Chul Lee

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  1. Sahnghoon Lee
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  2. Hyoungmin Kim
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Correspondence to Myung Chul Lee.

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Sahnghoon Lee and Hyoungmin Kim have contributed equally to the preparation of this article.

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Lee, S., Kim, H., Jang, J. et al. Comparison of anterior and rotatory laxity using navigation between single- and double-bundle ACL reconstruction: prospective randomized trial. Knee Surg Sports Traumatol Arthrosc 20, 752–761 (2012). https://doi.org/10.1007/s00167-012-1880-2

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