Background Single-bundle anterior cruciate ligament reconstruction seems to be insufficient to control a combined rotatory load of internal and valgus torque, whereas anatomical double-bundle reconstruction might produce a better biomechanical outcome, especially during rotatory loads. Hypothesis The addition of the posterolateral bundle to the anteromedial bundle, in an in vivo double-bundle computer-assisted anterior cruciate ligament reconstruction, is able to reduce the internal rotation of the tibia at different degrees of flexion. Study Design Controlled laboratory study. Methods Ten consecutive anterior cruciate ligament reconstruction procedures were performed in male patients using double-bundle gracilis and semitendinosus tendon graft with the 2.0 OrthoPilot anterior cruciate ligament navigation system. Anteroposterior displacement at 30°, 60°, and 90° as well as internal and external rotation at 0°, 15°, 30°, 45°, 60°, and 90° of knee flexion were evaluated before reconstruction, after fixation of the anteromedial bundle, and then after fixation of the posterolateral bundle. Results Fixation of the anteromedial bundle significantly (P <. 05) reduced the anteroposterior displacement at 30°, 60°, and 90° of knee flexion; the internal rotation at 15°, 30°, 45°, and 60°; and the external rotation at 0°, 30°, 60°, and 90°. The addition of the posterolateral bundle to the anteromedial bundle did not significantly reduce internal and external rotation of the tibia at degrees of flexion measured (P >. 05). Conclusion The hypothesis that the addition of the posterolateral bundle to the anteromedial bundle is able to reduce internal rotation of the tibia, minimizing the pivot-shift phenomenon, was not confirmed. Clinical Relevance The effective role of the anatomical double-bundle procedure in better restoring knee kinematics and allowing better clinical outcomes should be questioned in an in vivo model of anterior cruciate ligament reconstruction using doubled semitendinosus and gracilis graft.
A quantitative technique to create a femoral tunnel at the averaged center of the anteromedial bundle attachment in anatomic double-bundle anterior cruciate ligament reconstruction
