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

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.