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Intraoperative comparisons of knee kinematics of double-bundle versus single-bundle anterior cruciate ligament reconstruction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Based on biomechanical anatomical studies, double-bundle reconstruction of the anterior cruciate ligament (ACL) was introduced to achieve better stability in the knee, particularly in respect of rotatory loads. An in vivo, computer-assisted, double-bundle (DB) ACL reconstruction is superior to a single-bundle (SB) ACL reconstruction at reducing rotatory, and AP laxities of the tibia at 20 degrees of knee flexion and also during the pivot shift test.

Methods

The data of 63 patients who had ACL reconstruction were prospectively collected. Thirty-two patients had single-bundle reconstruction (SB group), and 31 received double-bundle reconstruction (DB group). The per-operative navigation system (Praxim ACL surgetics System) helped to search for a minimal anisometry profile of the grafts, which was favorable (graft loosened with flexion) in the anatomic area of ACL insertion and preventing any conflict between the graft and the femoral notch. The system also evaluated anteroposterior (AP) rotational stabilities and pivot shift. The value of the pivot shift was calculated from the values of the maximum rotation and AP translation obtained when performing the manoeuver before and after ACL reconstruction, comparing SB and DB reconstruction.

Results

The post-operative AP displacement of the lateral compartment during the Lachman test was statistically reduced in DB group in comparison with SB group (5.1 ± 4.4 mm vs. 7.1 ± 3.2 mm, P = 0.04), whereas the AP displacements of the medial compartment were also reduced (3.4 ± 3.7 mm vs. 4.5 ± 2.6 mm, P = 0.15) but with no statistical significance. Internal and external rotations at 20° of knee flexion were lower in the DB group than in SB group with statistical significance (respectively, 13.2 ± 4.9° vs. 17.5 ± 4.0°, P < 0.001 and 9.1 ± 3.6° vs. 11.5 ± 3.5°, P = 0.01). During the pivot shift test, the post-operative AP maximal translation was statistically different in both groups: 4.5 ± 2.1 mm in DB group and 6.3 ± 2.7 mm in SB group (P = 0.01)), whereas the maximal rotation was not statistically different: 3.8 ± 2.5° in DB group and 3.4 ± 1.2° in SB group (n.s.). Therefore, Colombet’s index was similar in DB group and SB group (respectively, 0.21 ± 0.16 and 0.17 ± 0.06, (n.s.)).

Conclusions

This study shows a significant intraoperative advantage in anterior and rotational stability for four-tunnel DB ACL reconstruction compared with SB ACL reconstruction.

Level of evidence

II.

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References

  1. Aglietti P, Giron F, Losco M, Cuomo P, Ciardullo A, Mondanelli N (2010) Comparison between single-and double-bundle anterior cruciate ligament reconstruction: a prospective, randomized, single-blinded clinical trial. Am J Sports Med 38:25–34

    Article  PubMed  Google Scholar 

  2. Belisle AL, Bicos J, Geaney L, Andersen MH, Obopilwe E, Rincon L, Nyland J, Morgan C, Caborn DN, Arciero RA (2007) Strain pattern comparison of double and single bundle anterior cruciate ligament reconstruction techniques with the nativ anterior cruciate ligament. Arthroscopy 23:1210–1217

    Article  PubMed  Google Scholar 

  3. Bignozzi S, Zaffagnini S, Lopomo N, Fu FH, Irrgang JJ, Marcacci M (2010) Clinical relevance of static and dynamic tests after anatomical double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 18:37–42

    Article  PubMed  Google Scholar 

  4. Brophy RH, Pearle AD (2009) Single-bundle anterior cruciate ligament reconstruction: a comparison of conventional, central, and horizontal single-bundle virtual graft positions. Am J Sports Med 37:1317–1323

    Article  PubMed  Google Scholar 

  5. Colombet P, Robinson J, Jambou S, Allard M, Bousquet V, de Lavigne C (2006) Two-bundle, four-tunnel anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 14:629–636

    Article  PubMed  Google Scholar 

  6. Colombet P, Robinson J, Christel P, Franceschi JP, Djian P (2007) Using navigation to measure rotation kinematics during ACL reconstruction. Clin Orthop Relat Res 454:59–65

    Article  PubMed  Google Scholar 

  7. Daniel DM, Stone ML, Sachs R, Malcom L (1985) Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption. Am J Sports Med 13:401–407

    Article  PubMed  CAS  Google Scholar 

  8. Edixhoven P, Huiskes R, de Graaf R, van Rens TJ, Slooff TJ (1987) Accuracy and reproducibility of instrumented knee- drawer tests. J Orthop Res 5:378–387

    Article  PubMed  CAS  Google Scholar 

  9. Edwards A, Bull AM, Amis AA (2008) The attachments of the anteromedial and posterolateral fibre bundles of the anterior cruciate ligament. Part 2: femoral attachment. Knee Surg Sports Traumatol Arthrosc 16:29–36

    Article  PubMed  Google Scholar 

  10. Eriksson E (1997) How good are the results of ACL reconstruction? Knee Surg Sports Traumatol Arthrosc 5:137

    Article  PubMed  CAS  Google Scholar 

  11. Ferretti A, Monaco E, Labianca L, Conteduca F, De Carli A (2008) Double- bundle anterior cruciate ligament reconstruction: a computer-assisted orthopaedic surgery study. Am J Sports Med 36:760–766

    Article  PubMed  Google Scholar 

  12. Ferretti A, Monaco E, Labianca L, De Carli A, Maestri B, Conteduca F (2009) Double-bundle anterior cruciate ligament reconstruction: a comprehensive kinematic study using navigation. Am J Sports Med 37:1548–1553

    Article  PubMed  Google Scholar 

  13. Fleute M, Lavallee S, Julliard R (1999) Incorporating a statistically based shape model into a system for computer assisted anterior cruciate ligament surgery. Med Image Anal 3:209–222

    Article  PubMed  CAS  Google Scholar 

  14. Gabriel MT, Wong EK, Woo SL, Yagi M, Debski RE (2004) Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads. J Orthop Res 22:85–89

    Article  PubMed  Google Scholar 

  15. Galway H, MacIntosh DL (1980) The lateral pivot-shift: a symptom and sign of anterior cruciate ligament insufficiency. Clin Orthop Relat Res 147:45–50

    PubMed  Google Scholar 

  16. Ho JY, Gardiner A, Shah V, Steiner ME (2009) Equal kinematics between central anatomic single-bundle and double-bundle anterior cruciate ligament reconstructions. Arthroscopy 25:464–472

    Article  PubMed  Google Scholar 

  17. Hofbauer M, Valentin P, Kdolsky R, Ostermann RC, Graf A, Figl M, Aldrian S (2010) Rotational and translation laxity after computer-navigated single- and double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1201–1207

    Article  PubMed  CAS  Google Scholar 

  18. Hoshino Y, Kuroda R, Nagamune K, Yagi M, Mizuno K, Yamagushi M, Muratsu H, Yoshiya S, Kurosaka M (2007) In vivo measurement of the pivot-shift test in the anterior cruciate ligament–deficient knee using an electromagnetic device. Am J Sports Med 35:1098–1104

    Article  PubMed  Google Scholar 

  19. Ishibashi Y, Tsuda E, Yamamoto Y, Tsukada H, Toh S (2009) Navigation evaluation of the pivot-shift phenomenon during double-bundle anterior cruciate ligament reconstruction: is the posterolateral bundle more important ? Arthroscopy 25:488–495

    Article  PubMed  Google Scholar 

  20. Ishibashi Y, Tsuda E, Tazawa K, Sato H, Toh S (2005) Intraoperative evaluation of the anatomical double-bundle anterior cruciate ligament reconstruction with OrthoPilot navigation system. Orthopedics 28(suppl 10):s1277–s1282

    PubMed  Google Scholar 

  21. Kanaya A, Ochi M, Deie M, Adachi N, Nishimori M, Nakamae A (2009) Intraoperative evaluation of anteroposterior and rotational stabilities in anterior cruciate ligament reconstruction: lower femoral tunnel placed single-bundle versus double-bundle reconstruction. Knee Surg Sports Traumatol Arthrosc 17:907–913

    Article  PubMed  Google Scholar 

  22. Kaplan N, Wickiewicz TL, Warren RF (1990) Primary surgical treatment of anterior cruciate ligament ruptures: a long-term followup study. Am J Sports Med 18:354–358

    Article  PubMed  CAS  Google Scholar 

  23. Kendoff D, Citak M, Voos J, Pearle AD (2009) Surgical navigation in knee ligament reconstruction. Clin Sports Med 28:41–50

    Article  PubMed  CAS  Google Scholar 

  24. Koh J (2005) Computer-assisted navigation and anterior cruciate ligament reconstruction: accuracy and outcomes. Orthopedics 28(suppl 10):s1283–s1287

    PubMed  Google Scholar 

  25. Lane CG, Warren RF, Stanford FC, Kendoff D, Pearle AD (2008) In vivo analysis of the pivot shift phenomenon during computer navigated ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 16:487–492

    Article  PubMed  Google Scholar 

  26. Lewis PB, Parameswaran AD, Rue JP, Bach BR Jr (2008) Systematic review of single-bundle anterior cruciate ligament reconstruction outcomes: a baseline assessment for consideration of double-bundle techniques. Am J Sports Med 36:2028–2036

    Article  PubMed  Google Scholar 

  27. Markolf KL, Park S, Jackson SR, McAllister DR (2009) Anterior-posterior and rotatory stability of single and double-bundle anterior cruciate ligament reconstructions. J Bone Joint Surg Am 91:107–118

    Article  PubMed  Google Scholar 

  28. Markolf KL, Park S, Jackson SR, McAllister DR (2008) Simulated pivot-shift testing with single and double-bundle anterior cruciate ligament reconstructions. J Bone Joint Surg Am 90:1681–1689

    Article  PubMed  Google Scholar 

  29. Musahl V, Voos J, O’Loughlin PF, Stueber V, Kendoff D, Pearle AD (2010) Mechanized pivot shift test achieves greater accuracy than manual pivot shift test. Knee Surg Sports Traumatol Arthrosc 18:1208–1213

    Article  PubMed  Google Scholar 

  30. Pearle AD, Solomon DJ, Wanich T et al (2007) Reliability of navigated knee stability examination: a cadaveric evaluation. Am J Sports Med 35:1315–1320

    Article  PubMed  Google Scholar 

  31. Pearle AD, Kendoff D, Musahl V, Warren RF (2009) The pivot-shift phenomenon during computer-assisted anterior cruciate ligament reconstruction. J Bone Joint Surg Am 91:115–118

    Article  PubMed  Google Scholar 

  32. Petersen W, Zantop T (2007) Anatomy of the anterior cruciate ligament with regard to its two bundles. Clin Orthop Relat Res 454:35–47

    Article  PubMed  Google Scholar 

  33. Plaweski S, Cazal J, Rosell P, Merloz P (2006) Anterior cruciate ligament reconstruction using navigation: a comparative study on 60 patients. Am J Sports Med 34:542–552

    Article  PubMed  Google Scholar 

  34. Pombo MW, Shen W, Fu FH (2008) Anatomic double-bundle anterior cruciate ligament reconstruction: where are we today? Arthroscopy 24:1168–1177

    Article  PubMed  Google Scholar 

  35. Ristanis S, Stergiou N, Patras K, Vasiliadis HS, Giakas G, Georgoulis AD (2005) Excessive tibial rotation during high-demand activities is not restored by anterior cruciate ligament reconstruction. Arthroscopy 21:1323–1329

    Article  PubMed  Google Scholar 

  36. Robinson J, Carrat L, Granchi C, Colombet P (2007) Influence of anterior cruciate ligament bundles on knee kinematics: clinical assessment using computer-assisted navigation. Am J Sports Med 35:2006–2013

    Article  PubMed  Google Scholar 

  37. Sakane M, Fox RJ, Woo SL, Livesay GA, Li G, Fu FH (1997) In situ forces in the anterior cruciate ligament and its bundles in response to anterior tibial loads. J Orthop Res 15:285–293

    Article  PubMed  CAS  Google Scholar 

  38. Seon JK, Park SJ, Lee KB, Yoon TR, Seo HY, Song EK (2009) Stability comparison of anterior cruciate ligament between double- and single-bundle reconstructions. Int Orthop 33:425–429

    Article  PubMed  Google Scholar 

  39. Shelbourne KD, Gray T (1997) Anterior cruciate ligament reconstruction with autogenous patellar tendon graft followed by accelerated rehabilitation: a two- to nine-year follow-up. Am J Sports Med 25:786–795

    Article  PubMed  CAS  Google Scholar 

  40. Tashman S, Collon D, Anderson K, Kolowich P, Anderst W (2004) Abnormal rotational knee motion during running after anterior cruciate ligament reconstruction. Am J Sports Med 32:975–983

    Article  PubMed  Google Scholar 

  41. Tsai AG, Wijdicks CA, Walsh MP, Laprade RF (2010) Comparative kinematic evaluation of all-inside single-bundle and double-bundle anterior cruciate ligament reconstruction: a biomechanical study. Am J Sports Med 38:263–272

    Article  PubMed  Google Scholar 

  42. Yagi M, Wong EK, Kanamori A, Debski RE, Fu FH, Woo SL (2002) Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med 30:660–666

    PubMed  Google Scholar 

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Authors and Affiliations

  1. CHU Grenoble, Echirolles, France

    Stephane Plaweski, Mathieu Grimaldi, Aurélien Courvoisier & Simon Wimsey

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  1. Stephane Plaweski
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Correspondence to Stephane Plaweski.

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Plaweski, S., Grimaldi, M., Courvoisier, A. et al. Intraoperative comparisons of knee kinematics of double-bundle versus single-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 19, 1277–1286 (2011). https://doi.org/10.1007/s00167-011-1405-4

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