Outcomes Following Arthroscopic Single and Double Bundle Anterior Cruciate Ligament (ACL) Reconstruction Supported by the Comprehensive Early Rehabilitation Program (CERP)

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.

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Postoperative Pain And Medication Use: Single Versus Double Bundle Anterior Cruciate Ligament (acl) Reconstruction

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000353308.00152.4e ◽

2009 ◽

Vol 41 ◽

pp. 16

Author(s):

Brad Monteleone ◽

Mark Heard ◽

Laurie A. Hiemstra ◽

Treny M. Sasyniuk

Keyword(s):

Anterior Cruciate Ligament ◽

Postoperative Pain ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Medication Use ◽

Double Bundle ◽

Anterior Cruciate ◽

Single Versus

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118811293 ◽

2018 ◽

Vol 6 (12) ◽

pp. 232596711881129 ◽

Cited By ~ 3

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.

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Review Article: Anatomic Double Bundle Anterior Cruciate Ligament Reconstruction

Journal of Orthopaedic Surgery ◽

10.1177/230949900701500219 ◽

2007 ◽

Vol 15 (2) ◽

pp. 216-221 ◽

Cited By ~ 34

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.

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

Computational and Mathematical Methods in Medicine ◽

10.1155/2014/948292 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 4

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.

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A Prospective Comparison of Postoperative Pain and Medication Use Between Single and Double Bundle Anterior Cruciate Ligament (ACL) Reconstruction (SS-45)

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2009.04.044 ◽

2009 ◽

Vol 25 (6) ◽

pp. e24-e25

Author(s):

Mark Heard ◽

Laurie A. Hiemstra ◽

Treny M. Sasyniuk ◽

Bradley J. Monteleone

Keyword(s):

Anterior Cruciate Ligament ◽

Postoperative Pain ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Medication Use ◽

Double Bundle ◽

Prospective Comparison ◽

Anterior Cruciate

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

Journal of Clinical Medicine ◽

10.3390/jcm10081625 ◽

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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Single-Bundle versus Double-Bundle Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Controlled Trial with 6-Year Follow-up

The Journal of Knee Surgery ◽

10.1055/s-0037-1598176 ◽

2017 ◽

Vol 30 (09) ◽

pp. 898-904 ◽

Cited By ~ 10

Author(s):

Francesco Dini ◽

Laura de Girolamo ◽

Massimo Cattani ◽

Michele Rosa ◽

Paolo Adravanti

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Femoral Tunnel ◽

Cruciate Ligament ◽

Double Bundle ◽

Lysholm Score ◽

Single Bundle ◽

Randomized Controlled ◽

Anterior Cruciate

AbstractSingle-bundle (SB) anterior cruciate ligament (ACL) reconstruction is increasingly used in a large number of patients and it allows obtaining very good clinical and subjective results; however, functional tests show a persistent rotational instability. Biomechanical studies seem to indicate that double-bundle (DB) ACL reconstruction allows to obtain increased anterior and rotational stability compared with SB. The aim of this prospective randomized controlled study was to compare the clinical outcome and the possible osteoarthritic evolution of patients treated either with a SB (freehand transtibial femoral tunnel) or with a DB technique (outside-in for posterolateral femoral tunnel/inside-out for anteromedial femoral tunnel) at a final follow-up of 6 years. A total of 60 patients with complete ACL rupture (age, 16–40 years) were prospectively randomized to SB (n = 30) or DB (n = 30) groups. Patients were evaluated preoperatively and after surgery at 6 months, 1, 3, and 6 years with Lysholm score, International Knee Documentation Committee (IKDC) form, and KT-2000 (Medmetric Corp). The degree of osteoarthritis (OA) based on the Kellgren–Lawrence grade was also assessed. No significant differences in background factors between the two groups were observed. Homogeneity was also found in term of preoperative Lysholm score, IKDC, and KT-2000 between SB and DB groups. After 6 months from surgery, both groups showed significant improvements for Lysholm, IKDC, and KT-2000 score with respect to preoperative observations (p < 0.001); however, no significant differences have been observed in term of postoperative values between SB and DB groups at each time point (6-year evaluation: Lysholm score 98.14 ± 10.03 and 97.22 ± 12.82; IKDC normal + nearly normal 95 and 100%; KT-2000 1.68 ± 1.26 and 1.03 ± 1.92 for SB and DB, respectively; all p > 0.05). At the final follow-up, three patients (11.11%) in the DB group and two patients (7.69%) in the SB group presented signs of OA progression. Our study did not reveal any advantages in using DB ACL reconstruction in mid- to long-term follow-up in term of clinical outcome and knee stability, as well as in term of OA progression.

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