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A comparative study of single- and double-bundle ACL reconstructions in sheep
W J Radford1, A A Amis, S A Kempson
1Mechanical Engineering Department, Imperial College, London, UK.
Summary
A sheep study comparing anterior cruciate ligament (ACL) reconstructions found double-bundle surgery led to more joint degeneration. This suggests double-bundle ACL reconstruction may not be clinically superior despite complex surgery.
Area of Science:
- Orthopedic surgery
- Biomedical engineering
- Veterinary science
Background:
- In vitro studies suggest double-bundle anterior cruciate ligament (ACL) reconstruction offers superior knee stability.
- Clinical data is needed to validate these findings and support the use of double-bundle techniques.
Purpose of the Study:
- To compare the in vivo efficacy of double-bundle ACL reconstruction against single-bundle methods.
- To evaluate implant integration, joint stability, and degenerative changes in an animal model.
Main Methods:
- Three ACL reconstruction techniques (double-bundle, single-bundle condyle, single-bundle over the top) were performed on 24 sheep.
- Polyester fibre implants were used, and specimens were analyzed after 6 months in vivo.
- Evaluations included intra-articular tissue integration, implant integrity, joint laxity, and joint surface degeneration.
Main Results:
- All three ACL reconstruction methods showed similar fibrous tissue integration and no implant damage.
- Biomechanical testing revealed increased joint laxity compared to normal in all groups.
- The double-bundle ACL reconstruction group exhibited significantly more joint surface degeneration than the other groups.
Conclusions:
- The study does not support the clinical use of double-bundle ACL reconstruction due to increased joint degeneration.
- The complex surgical procedure did not yield superior biomechanical performance compared to simpler methods in this ovine model.