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Anterior cruciate ligament reconstruction using autologous hamstring double bundle graft compared with single bundle
S A R Ibrahim1, F Hamido, A K Al Misfer
1Department of Sports Unit, Al Razi Orthopaedic Hospital, Safat, Kuwait. samirabdulrazik@yahoo.com
The Journal of Bone and Joint Surgery. British Volume
|October 2, 2009
Summary
Anatomical double-bundle anterior cruciate ligament reconstruction demonstrated superior pivot-shift test results and reduced knee laxity compared to single-bundle techniques. All anterior cruciate ligament reconstruction methods improved patient outcomes, regardless of fixation technique.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Biomedical Engineering
Background:
- Anterior cruciate ligament (ACL) deficiency significantly impacts knee joint stability and function.
- Various surgical techniques exist for ACL reconstruction, aiming to restore knee stability and function.
- Comparing anatomical double-bundle versus single-bundle ACL reconstruction with different fixation methods is crucial for optimizing surgical outcomes.
Purpose of the Study:
- To compare the clinical outcomes of anatomical double-bundle ACL reconstruction with three single-bundle techniques using different femoral fixation devices.
- To evaluate the efficacy of different ACL reconstruction methods in restoring knee stability and function.
Main Methods:
- A randomized controlled trial involving 218 patients with unilateral ACL deficiency.
- Four groups: anatomical double-bundle (Group A), single-bundle with Endobutton (Group B), RigidFix (Group C), and TransFix II screw (Group D).
- Clinical evaluation included anterior drawer, Lachman, pivot-shift tests, KT-1000 arthrometer measurements, IKDC, Lysholm, and Tegner scores at a mean 29-month follow-up.
Main Results:
- No significant differences in range of motion or Lysholm scores among groups.
- The double-bundle technique showed significantly better pivot-shift test results (p = 0.002).
- KT-1000 measurements indicated less laxity in the double-bundle group (1.4 mm vs. 2.4 mm). Lachman and anterior drawer tests also favored the double-bundle method.
Conclusions:
- Anatomical double-bundle ACL reconstruction offers superior rotational stability compared to single-bundle techniques, particularly evident in pivot-shift test performance.
- While all ACL reconstruction methods improved patient status, the double-bundle approach demonstrated better objective stability measures.
- Fixation methods for single-bundle reconstruction did not show significant differences in this study, but the double-bundle technique provided enhanced clinical outcomes regarding laxity.