scholarly journals Review Article: Anatomic Double Bundle Anterior Cruciate Ligament Reconstruction

2007 ◽  
Vol 15 (2) ◽  
pp. 216-221 ◽  
Author(s):  
W Shen ◽  
S Jordan ◽  
F Fu
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Clinical Investigation ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Rotational Stability ◽  
Single Bundle ◽  
Osteoarthritic Change ◽  
Anterior Cruciate ◽  
Double Bundle Acl Reconstruction

The anterior cruciate ligament (ACL) consists of 2 bundles: a slightly larger anteromedial bundle and a posterolateral bundle, named according to their relative tibial insertion sites. Both bundles are crucial to knee stability. Although it is more technically demanding, a double bundle ACL reconstruction restores the knee biomechanics better and provides more rotational stability than a single bundle ACL reconstruction. Intermediate and long-term clinical investigation including the measurement of rotational laxity and the evaluation of osteoarthritic change is needed to confirm biomechanical and short-term clinical outcomes.

scholarly journals A prospective comparison of double- and single-bundle anterior cruciate ligament reconstructions

Medicina ◽  
2008 ◽  
Vol 44 (2) ◽  
pp. 110 ◽  
Author(s):  
Rimtautas Gudas ◽  
Alfredas Smailys ◽  
Kristina Vostrugina ◽  
Ramûnas Tamoðiûnas ◽  
Donatas Simonaitis ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Activity Level ◽  
Single Bundle ◽  
Prospective Comparison ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
Double Bundle Acl Reconstruction

Objective. A nonrandomized clinical study was performed to compare the clinical and radiological outcome between double-bundle and single-bundle anterior cruciate ligament (ACL) reconstructions with semitendinosus tendon in athletes. Material and methods. We examined 70 patients with unilateral anterior cruciate ligament injury. They were followed up for a mean of 24 months. Each group of 35 patients underwent either double- or singlebundle ACL reconstruction. The mean age of the patients was 24.7 years (range, 18–35 years). There were no differences between two groups regarding age at surgery, sex, follow-up period, period before surgery, combined meniscus injuries, athletic activity level, and International Knee Documentation Committee (IKDC) and Tegner scores. All patients followed the same postoperative program. They were evaluated using manual knee laxity tests, knee extension and flexion strength testing. General knee condition was evaluated by the IKDC and Tegner scores. Results. The results were excellent and good in 32 (91.4%) patients after double-bundle ACL reconstruction and in 30 (85.7%) patients after single-bundle ACL reconstruction, evaluating by IKDC system. However, statistical analysis showed no significant difference between the two groups regarding all IKDC-categorized data (P=0.87). The average scores of Tegner activity in double-bundle and single-bundle groups were 8.0 and 8.1, respectively. Conclusions. This trial showed no significant difference between the double and single-bundle ACL repairs.

scholarly journals Comparing post-operative pain between single bundle and double bundle anterior cruciate ligament reconstruction: a retrospective study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Chaiwat Chuaychoosakoon ◽  
Wachiraphan Parinyakhup ◽  
Arnan Wiwatboworn ◽  
Peeranut Purngpiputtrakul ◽  
Pawin Wanasitchaiwat ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Retrospective Study ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Single Bundle ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Anterior Cruciate ◽  
Double Bundle Acl Reconstruction

Abstract Background In anterior cruciate ligament (ACL) reconstruction, the clinical outcome and level of post-operative pain are important factors. To date there have been no studies evaluating differences in post-operative pain between single bundle and double bundle ACL reconstruction with a hamstring graft. Hypothesis/purpose We hypothesized that post-operative pain in single bundle ACL reconstruction would be less than in double bundle ACL reconstruction. This study was to compare post-operative pain between patients undergoing single bundle versus double bundle ACL reconstruction. Study design Cohort study. Methods This was a retrospective study comparing post-operative pain scores between single bundle and double bundle ACL reconstruction. Each patient was given our standard regimen of oral diclofenac (25 mg/tab) three times per day and paracetamol (500 mg/tab) six times per day for 1 day post-operatively. If the patient complained of moderate to severe pain (pain numeric rating scale (PNRS) > 3), 3 mg of morphine was injected intravenously every 3 h for 24 h and 1 mg of morphine as a rescue medication every 1 h for 24 h. PNRS and morphine consumption were recorded at 4-h intervals for 24 h. Results 209 patients were included in this study of whom 102 and 107 patients received single bundle and double bundle ACL reconstruction, respectively. The average post-operative pain scores of the single bundle group were lower at all time points. Linear mixed effect regression analyses showed that the single bungle group had lower post-operative pain than the double bundle group after adjusting for confounders (beta = − 0.45; 95% CI = − 0.838, − 0.062) but there was no statistically significant difference between numbers of bundle ACL reconstruction with regard to morphine consumption. Conclusion Single bundle ACL reconstruction had significantly lower post-operative pain scores than double bundle ACL reconstruction. Clinical relevance Double bundle ACL reconstruction results in higher post-operative pain, which may slow the start of rehabilitation and reduce patient satisfaction. In middle-aged adult patients with low-demand activities, we suggest performing a single bundle ACL reconstruction.

scholarly journals Double-bundle anterior cruciate ligament recontruction by Hamstring tendon autograft: the ALL - INSIDE technique

2019 ◽  
Vol 9 (2) ◽  
Author(s):  
Ngọc Trưởng Phạm ◽  
Hải Nam Vũ
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Double Bundle ◽  
Rotational Stability ◽  
Hamstring Tendon Autograft ◽  
Anterior Cruciate ◽  
Double Bundle Acl Reconstruction ◽  
Tendon Autograft

Tóm tắt Đặt vấn đề: Đánh giá kết quả đạt được trong việc tái tạo 2 bó dây chằng chéo trước All-inside, gân cơ Hamstring. (DCCT) với kỹ thuật “all-inside” bó sau ngoài sử dụng mảnh ghép gân cơ thon, gân cơ bán gân tự thân. Từ kết quả đạt được đưa ra một số nhận xét về kỹ thuật. Phương pháp nghiên cứu: Tiến cứu, mô tả cắt ngang 43 bệnh nhân tổn thương DCCT được lựa chọn chỉ định phẫu thuật nội soi tái tạo DCCT 2 bó bằng gân cơ bán gân và gân cơ thon tự thân với kỹ thuật “all-inside” bó sau ngoài tại Bệnh viện 198 Bộ Công an. Kết quả: 43 bệnh nhân trong lứa tuổi 19-35, thời gian theo dõi trung bình là 13,5 tháng. Kết quả bước đầu, bệnh nhân cải thiện rất tốt sự ổn định và chức năng của khớp gối nhất là ổn định xoay. Điểm Lysholm ở mức độ tốt và rất tốt đạt 95,4%. Tỷ lệ quay lại tập luyện thi đấu thể thao là 93,0% và chưa phát hiện bệnh nhân đứt lại DCCT sau tái tạo. Kết luận: Phẫu thuật tái tạo 2 bó DCCT với kỹ thuật “all-inside” bó sau ngoài có ưu điểm cố định được mảnh ghép ngắn, sử dụng được nguồn gân ghép tự thân, cho kết quả phục hồi chức năng tốt. Phẫu thuật góp phần nâng cao hiệu quả điều trị tái tạo DCCT, làm giảm nguy cơ phải sử dụng mảnh ghép đồng loại. Abstract Introduction: To evaluate the results obtained in the Double-Bundle Anterior Cruciate Ligament (ACL) Reconstruction of the hamstring tendon autograft with the "all-inside" technique Material and Methods: A prospective, cross-sectional study of 43 patients with indication for Double-Bundle Anterior Cruciate Ligament Reconstruction with hamstring tendon autograft Results: 43 patients between the ages of 19-35 years, with a mean follow-up of 13.5 months, 95,4% good and excellent Lysholm score and were shown to significantly improve rotational stability. The return to sport rate following ACL reconstruction was 93,0% and the graft failure rate was 0%. Conclusion: The hamstring tendon autograft can be used for the Double-Bundle ACL reconstruction with the "all-inside" technique. This technique can use short graft, resulting in good rehabilitation Keywords: ACL double-bundle reconstruction, “all-inside” technique, minimally invasive, hamstring tendon.

scholarly journals Anterolateral ligament of the knee: back to the future in anterior cruciate ligament reconstruction

2015 ◽  
Vol 7 (2) ◽  
Author(s):  
Davide Edoardo Bonasia ◽  
Andrea D'Amelio ◽  
Pietro Pellegrino ◽  
Federica Rosso ◽  
Roberto Rossi
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Anterolateral Ligament ◽  
Rotational Instability ◽  
Small Subset ◽  
Acl Injuries ◽  
Anterior Cruciate ◽  
Double Bundle Acl Reconstruction

Although the importance of the anterolateral stabilizing structures of the knee in the setting of anterior cruciate ligament (ACL) injuries has been recognized since many years, most of orthopedic surgeons do not take into consideration the anterolateral structures when performing an ACL reconstruction. Anatomic single or double bundle ACL reconstruction will improve knee stability, but a small subset of patients may experience some residual anteroposterior and rotational instability. For this reason, some researchers have turned again towards the anterolateral aspect of the knee and specifically the anterolateral ligament. The goal of this review is to summarize the existing knowledge regarding the anterolateral ligament of the knee, including anatomy, histology, biomechanics and imaging. In addition, the most common anterolateral reconstruction/tenodesis techniques are described together with their respective clinical outcomes.

Biomechanical Evaluation of Different Techniques in Double Bundle Anterior Cruciate Ligament Reconstruction Using Finite Element Analysis

2012 ◽  
Vol 13 ◽  
pp. 55-68 ◽  
Author(s):  
Rong Ying Huang ◽  
Hong Guang Zheng ◽  
Qiang Xu
Keyword(s):  
Finite Element ◽  
Anterior Cruciate Ligament ◽  
Soft Tissues ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Double Bundle ◽  
Rotational Stability ◽  
Single Bundle ◽  
Element Analysis ◽  
Anterior Cruciate

Anterior cruciate ligament injuries commonly in traffic accident, sports activities and extreme sports. Anterior cruciate ligament reconstruction is a common practice to help the patients restore the knee stability. However, there is no previous comparison study of single bundle reconstruction, double-femoral double-tibial tunnel reconstruction, single-femoral double-tibial tunnel reconstruction, and double-femoral single-tibial tunnel reconstruction with respect to biomechanical characteristics such as rotational stability, force and stress inside the ligament and grafts, stresses inside the soft tissues. In this study, we developed a pair of three-dimensional finite element models of a lower extremity including femur, tibia, fibula, cartilage, meniscus, and four major ligaments at 0°，25°，60° and 80°of knee flexion. Based on the intact models, single bundle reconstruction, double-femoral double-tibial tunnel reconstruction, single-femoral double-tibial tunnel reconstruction, and double-femoral single-tibial tunnel reconstruction models were also developed. Then, the anterior tibial translations, the forces and stresses inside the ACL and ACL replacements, as well as the stresses inside the menisci, femoral and tibial cartilage were predicted under a combined rotatory load of 10Nm valgus moment and 5 Nm internal torque, respectively using finite element analysis. The rotational stability, ligament forces and stresses in the menisci, femoral and tibial cartilage following double bundle augmentation were superior to the other reconstruction techniques, while there is little advantage in ligament stress compared to that of the single bundle reconstruction. We conclude that double-femoral double-tibial tunnel reconstruction may have advantages with regard to biomechanical characteristics such as rotational stability, force inside the ligament and grafts, stresses inside the soft tissues.

Double-Bundle Versus Single-Bundle Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study With 10-Year Results

2017 ◽  
Vol 45 (11) ◽  
pp. 2578-2585 ◽  
Author(s):  
Sally Järvelä ◽  
Tommi Kiekara ◽  
Piia Suomalainen ◽  
Timo Järvelä
Keyword(s):  
Acl Reconstruction ◽  
Screw Fixation ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Single Bundle ◽  
Significant Group ◽  
Kt 1000 ◽  
Anterior Cruciate ◽  
Double Bundle Acl Reconstruction

Background: A long-term follow-up comparing double-bundle and single-bundle techniques for anterior cruciate ligament (ACL) reconstruction has not been reported before. Hypothesis: Double-bundle ACL reconstruction may have fewer graft ruptures, lower rates of osteoarthritis (OA), and better stability than single-bundle reconstruction. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Ninety patients were randomized for double-bundle ACL reconstruction with bioabsorbable screw fixation (DB group; n = 30), single-bundle ACL reconstruction with bioabsorbable screw fixation (SBB group; n = 30), and single-bundle ACL reconstruction with metallic screw fixation (SBM group; n = 30). Evaluation methods consisted of a clinical examination, KT-1000 arthrometer measurements, International Knee Documentation Committee (IKDC) and Lysholm knee scores, and a radiographic examination of both the operated and contralateral knees. Results: Eighty-one patients (90%) were available at the 10-year follow-up. Eleven patients (1 in the DB group, 7 in the SBB group, and 3 in the SBM group) had a graft failure during the follow-up and went on to undergo revision ACL surgery ( P = .043). In the remaining 70 patients at 10 years, no significant group differences were found in the pivot-shift test findings, KT-1000 arthrometer measurements, or knee scores. The most OA findings were found in the medial compartment of the knee, with 38% of the patients in the operated knee and 28% of the patients in the contralateral nonoperated knee. However, no significant group difference was found. The most severe OA changes were in the patients who had the longest delay from the primary injury to ACL reconstruction ( P = .047) and in the patients who underwent partial meniscal resection at the time of ACL reconstruction ( P = .024). Conclusion: Double-bundle ACL reconstruction resulted in significantly fewer graft failures than single-bundle ACL reconstruction during the follow-up. Knee stability and OA rates were similar at 10 years. The most severe OA changes were found in the patients who had the longest delay from the primary injury to ACL reconstruction and in the patients who underwent partial meniscal resection at the time of ACL reconstruction.

scholarly journals Effects of Remnant Tissue Preservation on Tunnel Enlargement After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Using the Hamstring Tendon

2018 ◽  
Vol 6 (12) ◽  
pp. 232596711881129 ◽  
Author(s):  
Tetsuro Masuda ◽  
Eiji Kondo ◽  
Jun Onodera ◽  
Nobuto Kitamura ◽  
Masayuki Inoue ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Tissue Preservation ◽  
Tunnel Enlargement ◽  
Level Of Evidence ◽  
Anterior Cruciate ◽  
Double Bundle Acl Reconstruction ◽  
Tunnel Positions

Background: The effects of remnant tissue preservation on tunnel enlargement after anatomic double-bundle anterior cruciate ligament (ACL) reconstruction have not yet been established. Hypothesis: The preservation of ACL remnant tissue may significantly reduce the degree and incidence of tunnel enlargement after anatomic double-bundle ACL reconstruction, while the remnant-preserving procedure may not significantly increase the incidence of tunnel coalition after surgery. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 79 patients underwent anatomic double-bundle ACL reconstruction. Based on the Crain classification of ACL remnant tissue, 40 patients underwent the remnant-preserving procedure (group P), and the remaining 39 patients underwent the remnant-resecting procedure (group R). There were no differences between the 2 groups concerning all background factors, including preoperative knee instability and intraoperative tunnel positions. All patients were examined using computed tomography and a standard physical examination at 2 weeks and 1 year after surgery. Results: During surgery, the femoral and tibial anteromedial (AM) tunnel sizes in both groups averaged 6.6 and 6.5 mm, respectively. The femoral and tibial posterolateral (PL) tunnel sizes in both groups averaged 6 and 6 mm, respectively. There were no differences in the intraoperative tunnel positions and tunnel sizes between groups. Concerning the femoral AM tunnel, the degree of tunnel enlargement in the oblique coronal and oblique axial views in group P was significantly less than that in group R ( P = .0068 and .0323, respectively). Regarding the femoral AM tunnel cross-sectional area, the degree and incidence of tunnel enlargement in group P were significantly less than those in group R ( P = .0086 and .0278, respectively). There were no significant differences in tunnel coalition between groups. In each group, there were no significant relationships between tunnel enlargement and each clinical outcome. Conclusion: Remnant preservation in anatomic double-bundle ACL reconstruction reduced enlargement of the femoral AM tunnel and did not increase the incidence of tunnel coalition. This is one of the advantages of remnant-preserving ACL reconstruction.

scholarly journals Single- or Double-Bundle Technique in the Anterior Cruciate Ligament Reconstruction — Current Concepts and Review of the Literature

2016 ◽  
Vol 1 (s2) ◽  
pp. 8-12
Author(s):  
Radu Fleaca ◽  
Radu Prejbeanu ◽  
Andrei-Marian Feier ◽  
Octav Russu ◽  
Adrian Todor ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Surgical Reconstruction ◽  
Single Bundle ◽  
Bundle Versus ◽  
Functional Benefit ◽  
Anterior Cruciate ◽  
Double Bundle Acl Reconstruction ◽  
Acl Deficient

AbstractThe treatment for anterior cruciate ligament (ACL) deficient knee consists in its surgical reconstruction. There are several available and validated techniques, but there are still numerous questions to be answered concerning the best approach in terms of stability, functional outcome, and avoiding further damage in the knee. This paper sought to analyze the studies published in the literature comparing the outcomes of ACL restoration with single-bundle versus double-bundle techniques. The results demonstrate that even if biomechanical studies find an increased steadiness with double-bundle ACL reconstruction, there seems to be no clinical or functional benefit compared with single-bundle reconstruction.

scholarly journals Influence of Bundle Diameter and Attachment Point on Kinematic Behavior in Double Bundle Anterior Cruciate Ligament Reconstruction Using Computational Model

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Oh Soo Kwon ◽  
Tserenchimed Purevsuren ◽  
Kyungsoo Kim ◽  
Won Man Park ◽  
Tae-Kyu Kwon ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Pivot Shift Test ◽  
Tibial Rotation ◽  
Attachment Point ◽  
Anterior Cruciate ◽  
Double Bundle Acl Reconstruction

A protocol to choose the graft diameter attachment point of each bundle has not yet been determined since they are usually dependent on a surgeon’s preference. Therefore, the influence of bundle diameters and attachment points on the kinematics of the knee joint needs to be quantitatively analyzed. A three-dimensional knee model was reconstructed with computed tomography images of a 26-year-old man. Based on the model, models of double bundle anterior cruciate ligament (ACL) reconstruction were developed. The anterior tibial translations for the anterior drawer test and the internal tibial rotation for the pivot shift test were investigated according to variation of bundle diameters and attachment points. For the model in this study, the knee kinematics after the double bundle ACL reconstruction were dependent on the attachment point and not much influenced by the bundle diameter although larger sized anterior-medial bundles provided increased stability in the knee joint. Therefore, in the clinical setting, the bundle attachment point needs to be considered prior to the bundle diameter, and the current selection method of graft diameters for both bundles appears justified.

scholarly journals Biomechanical Difference between Conventional Transtibial Single-Bundle and Anatomical Transportal Double-Bundle Anterior Cruciate Ligament Reconstruction Using Three-Dimensional Finite Element Model Analysis

2021 ◽  
Vol 10 (8) ◽  
pp. 1625
Author(s):  
Jae Gyoon Kim ◽  
Kyoung Tak Kang ◽  
Joon Ho Wang
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Three Dimensional ◽  
Element Model ◽  
Double Bundle ◽  
Contact Stresses ◽  
Single Bundle ◽  
Anterior Cruciate

The purpose of our study was to analyze the graft contact stress at the tunnel after transtibial single-bundle (SB) and transportal double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. After transtibial SB (20 cases) and transportal DB (29 cases) ACL reconstruction, the three-dimensional image of each patient made by postoperative computed tomography was adjusted to the validation model of a normal knee and simulated SB and DB ACL reconstructions were created based on the average tunnel position and direction of each group. We also measured graft and contact stresses at the tunnel after a 134 N anterior load from 0° to 90° flexion. The graft and contact stresses became the greatest at 30° and 0° flexion, respectively. The total graft and contact stresses after DB ACL reconstruction were greater than those after SB ACL reconstruction from 0° to 30° and 0° to 90° knee flexion, respectively. However, the graft and contact stresses of each graft after DB ACL reconstruction were less than those after SB ACL reconstruction. In conclusion, the total graft and total contact stresses after DB ACL reconstruction are higher than those after SB ACL reconstruction from 0° to 30° and 0° to 90° knee flexion, respectively. However, the stresses of each graft after DB ACL reconstruction are about half of those after SB ACL reconstruction.

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