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Anatomic single- and double-bundle ACL reconstruction both restore dynamic knee function: a randomized clinical

Scott Tashman1, Payam Zandiyeh1, James J Irrgang2,3

  • 1Steadman Philippon Research Institute, Vail, CO, USA.

Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA
|February 22, 2021
PubMed
Summary

Anatomic double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) did not provide superior knee kinematics compared to single-bundle (SB) ACLR. Both surgical techniques similarly restored near-normal dynamic knee function in patients with average ACL insertion sites.

Keywords:
ACL reconstructionAnatomic double-bundleAnatomic single-bundleAnterior cruciate ligamentKinematicsRandomized clinical trial

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Area of Science:

  • Orthopedic surgery
  • Biomechanics
  • Sports medicine

Background:

  • Anterior cruciate ligament (ACL) tears are common injuries, often requiring surgical reconstruction.
  • Single-bundle (SB) and double-bundle (DB) techniques are surgical options for ACL reconstruction (ACLR).
  • Restoring normal knee kinematics is crucial for functional recovery after ACLR.

Purpose of the Study:

  • To compare knee kinematics between anatomic single-bundle (SB) and double-bundle (DB) ACLR during downhill running.
  • To evaluate if DB ACLR better restores tibio-femoral kinematics compared to SB ACLR.
  • To assess kinematic outcomes at 6 and 24 months post-surgery using dynamic stereo X-ray imaging.

Main Methods:

  • Randomized controlled trial involving 57 active individuals (14-50 years) undergoing SB or DB ACLR.
  • Utilized a 10 mm quadriceps tendon autograft with a patellar bone block for reconstruction.
  • Assessed 3D tibio-femoral kinematics during treadmill downhill running at 6 and 24 months post-surgery.

Main Results:

  • No significant kinematic differences were observed between SB and DB ACLR groups at either 6 or 24 months.
  • Fifty-one subjects (89.5%) completed the 2-year follow-up.
  • Primary kinematic variables showed no superiority for either surgical technique.

Conclusions:

  • Contrary to hypothesis, DB ACLR did not demonstrate superior kinematic outcomes over SB ACLR.
  • Both SB and DB ACLR techniques effectively restored near-normal dynamic knee function.
  • Anatomic SB and DB ACLR are suitable options for patients with average-sized ACL insertion sites.