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Double-bundle anterior cruciate ligament reconstruction: a comprehensive kinematic study using navigation
Andrea Ferretti1, Edoardo Monaco, Luca Labianca
1Sapienza University of Rome, II School of Medicine, Orthopaedic Unit and Kirk Kilgour Sports Injury Center, Sant'Andrea Hospital, Rome, Italy. aferretti51@virgilio.it
The American Journal of Sports Medicine
|July 1, 2009
Summary
Anatomical double-bundle anterior cruciate ligament reconstruction with doubled semitendinosus and gracilis grafts did not significantly improve rotational stability. The study questions the clinical benefit of this specific double-bundle technique for anterior cruciate ligament (ACL) reconstruction.
Area of Science:
- Orthopedics
- Biomechanical Engineering
- Sports Medicine
Background:
- Single-bundle anterior cruciate ligament (ACL) reconstruction may not adequately address combined rotatory loads.
- Anatomical double-bundle reconstruction is hypothesized to offer superior biomechanical control, particularly during rotational stress.
Purpose of the Study:
- To evaluate the in vivo effect of adding a posterolateral bundle to an anteromedial bundle in computer-assisted ACL reconstruction.
- To determine if this anatomical double-bundle technique reduces tibial internal rotation.
Main Methods:
- A controlled laboratory study involving ten male patients undergoing ACL reconstruction.
- Utilized a double-bundle gracilis and semitendinosus tendon graft with the OrthoPilot navigation system.
- Assessed anteroposterior displacement and internal/external rotation at various knee flexion angles before and after bundle fixation.
Main Results:
- Fixation of the anteromedial bundle significantly reduced anteroposterior displacement and internal/external rotation at specific flexion angles.
- The addition of the posterolateral bundle did not yield statistically significant reductions in tibial internal or external rotation.
- The hypothesis regarding reduced internal rotation with the double-bundle technique was not confirmed.
Conclusions:
- The anatomical double-bundle anterior cruciate ligament reconstruction technique, using doubled semitendinosus and gracilis grafts, did not confirm the hypothesis of reduced internal tibial rotation.
- The clinical relevance and effectiveness of this specific anatomical double-bundle procedure in restoring knee kinematics and improving outcomes warrant further investigation.