Skip to main content
Top
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 9/2013

01-09-2013 | Knee

Arthroscopic single-bundle ACL reconstruction with modified double-layer bone-patellar tendon-bone allograft

Authors: Hui Jun Kang, Yan Ling Su, Hui Jian Cao, Fei Wang, Da Hai Yu, Zhi Min Zheng, Ying Ze Zhang

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2013

Login to get access

Abstract

Purpose

The objective of present study was to introduce a modified double-layer bone-patellar tendon-bone (BPTB) allograft for arthroscopic single-bundle ACL reconstruction and investigate the clinical outcomes.

Methods

From 2007 to 2009, a total of 136 patients underwent arthroscopic single-bundle ACL reconstructions with BPTB allograft. Of which, 66 patients were with double-layer BPTB allograft (Group 1), and 70 patients were with conventional BPTB allograft (Group 2). Clinical outcomes including Lachman and pivot-shift tests, KT-1000 arthrometer measurements, and Lysholm and Tegner activity scores were compared between the two groups at a 2-year minimum follow-up.

Results

Forty-six patients in each group were at a two-year minimum follow-up. The mean side-to-side difference on the KT-1000 arthrometer was 1.2 ± 1.2 mm for group 1 and 2.1 ± 1.9 mm for group 2, with significant difference between the two groups (p = 0.017). The knee function was significantly better for group 1 than for group 2, because the mean Lysholm score was 94.2 ± 4.8 points versus 86.6 ± 7.1 points (p = 0.000), and the median Tegner score was 8 (range 5–10) points versus 6 (range 4–10) points (p = 0.001).

Conclusions

On the basis of the KT-1000 arthrometer evaluation and clinical measures, single-bundle ACL reconstruction with double-layer BPTB allograft achieves significantly lesser anterior laxity and better knee function than a single-layer allograft reconstruction.

Level of evidence

Therapeutic, retrospective comparative study, Level III.
Literature
1.
go back to reference 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 38:25–34PubMedCrossRef 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 38:25–34PubMedCrossRef
2.
go back to reference Araujo PH, van Eck CF, Macalena JA, Fu FH (2011) Advances in the three-portal technique for anatomical single- or double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 19:1239–1242PubMedCrossRef Araujo PH, van Eck CF, Macalena JA, Fu FH (2011) Advances in the three-portal technique for anatomical single- or double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 19:1239–1242PubMedCrossRef
3.
go back to reference Barber FA, Aziz-Jacobo J, Oro FB (2010) Anterior cruciate ligament reconstruction using patellar tendon allograft: an age-dependent outcome evaluation. Arthroscopy 26:488–493PubMedCrossRef Barber FA, Aziz-Jacobo J, Oro FB (2010) Anterior cruciate ligament reconstruction using patellar tendon allograft: an age-dependent outcome evaluation. Arthroscopy 26:488–493PubMedCrossRef
4.
go back to reference Butler DL, Grood ES, Noyes FR, Olmstead ML, Hohn RB, Arnoczky SP, Siegel MG (1989) Mechanical properties of primate vascularized vs nonvascularized patellar tendon grafts: changes over time. J Orthop Res 7:68–79PubMedCrossRef Butler DL, Grood ES, Noyes FR, Olmstead ML, Hohn RB, Arnoczky SP, Siegel MG (1989) Mechanical properties of primate vascularized vs nonvascularized patellar tendon grafts: changes over time. J Orthop Res 7:68–79PubMedCrossRef
5.
go back to reference Cooper DE (1998) Biomechanical properties of the central third patellar tendon graft: effect of rotation. Knee Surg Sports Traumatol Arthrosc 6:S16–S19PubMedCrossRef Cooper DE (1998) Biomechanical properties of the central third patellar tendon graft: effect of rotation. Knee Surg Sports Traumatol Arthrosc 6:S16–S19PubMedCrossRef
6.
go back to reference Cooper DE, Deng XH, Burnstein AL (1993) The strength of the central third patellar tendon graft: a biomechanical study. Am J Sports Med 21:818–824PubMedCrossRef Cooper DE, Deng XH, Burnstein AL (1993) The strength of the central third patellar tendon graft: a biomechanical study. Am J Sports Med 21:818–824PubMedCrossRef
7.
go back to reference Daniel DM, Malcom LL, Losse G, Stone ML, Sachs R, Burks R (1985) Instrumented measurement of anterior laxity of the knee. J Bone Joint Surg Am 67:720–726PubMed Daniel DM, Malcom LL, Losse G, Stone ML, Sachs R, Burks R (1985) Instrumented measurement of anterior laxity of the knee. J Bone Joint Surg Am 67:720–726PubMed
8.
go back to reference Drogset JO, Grøntvedt T, Tegnander A (2005) Endoscopic reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone grafts fixed with bioabsorbable or metal interference screws: a prospective randomized study of the clinical outcome. Am J Sports Med 33:1160–1165PubMedCrossRef Drogset JO, Grøntvedt T, Tegnander A (2005) Endoscopic reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone grafts fixed with bioabsorbable or metal interference screws: a prospective randomized study of the clinical outcome. Am J Sports Med 33:1160–1165PubMedCrossRef
9.
go back to reference Grood ES, Walz-Hasselfeld KA, Holden JP, Noyes FR, Levy MS, Butler DL, Jackson DW, Drez DJ (1992) The correlation between anterior-posterior translation and cross-sectional area of anterior cruciate ligament reconstructions. J Orthop Res 6:878–885CrossRef Grood ES, Walz-Hasselfeld KA, Holden JP, Noyes FR, Levy MS, Butler DL, Jackson DW, Drez DJ (1992) The correlation between anterior-posterior translation and cross-sectional area of anterior cruciate ligament reconstructions. J Orthop Res 6:878–885CrossRef
10.
go back to reference Guo L, Yang L, Duan XJ, He R, Chen GX, Wang FY, Zhang Y (2012) Anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft: comparison of autograft, fresh-frozen allograft, and γ-irradiated allograft. Arthroscopy 28:211–217PubMedCrossRef Guo L, Yang L, Duan XJ, He R, Chen GX, Wang FY, Zhang Y (2012) Anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft: comparison of autograft, fresh-frozen allograft, and γ-irradiated allograft. Arthroscopy 28:211–217PubMedCrossRef
11.
go back to reference Hamner DL, Brown CH Jr, Steiner ME, Hecker AT, Hayes WC (1999) Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: biomechanical evaluation of the use of multiple strands and tensioning techniques. J Bone Joint Surg Am 81:549–557PubMed Hamner DL, Brown CH Jr, Steiner ME, Hecker AT, Hayes WC (1999) Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: biomechanical evaluation of the use of multiple strands and tensioning techniques. J Bone Joint Surg Am 81:549–557PubMed
12.
go back to reference Kim SJ, Chang JH, Kim TW, Jo SB, Oh KS (2009) Anterior cruciate ligament reconstruction with use of a single or double-bundle technique in patients with generalized ligamentous laxity. J Bone Joint Surg Am 91:257–262PubMedCrossRef Kim SJ, Chang JH, Kim TW, Jo SB, Oh KS (2009) Anterior cruciate ligament reconstruction with use of a single or double-bundle technique in patients with generalized ligamentous laxity. J Bone Joint Surg Am 91:257–262PubMedCrossRef
13.
go back to reference Laoruengthana A, Pattayakorn S, Chotanaputhi T, Kosiyatrakul A (2009) Clinical comparison between six-strand hamstring tendon and patellar tendon autograft in arthroscopic anterior cruciate ligament reconstruction: a prospective, randomized clinical trial. J Med Assoc Thai 92:491–497PubMed Laoruengthana A, Pattayakorn S, Chotanaputhi T, Kosiyatrakul A (2009) Clinical comparison between six-strand hamstring tendon and patellar tendon autograft in arthroscopic anterior cruciate ligament reconstruction: a prospective, randomized clinical trial. J Med Assoc Thai 92:491–497PubMed
14.
go back to reference Marder RA, Raskind JR, Carroll M (1991) Prospective evaluation of arthroscopically assisted anterior cruciate ligament reconstruction: patellar tendon versus semitendinosus and gracilis tendons. Am J Sports Med 19:478–484PubMedCrossRef Marder RA, Raskind JR, Carroll M (1991) Prospective evaluation of arthroscopically assisted anterior cruciate ligament reconstruction: patellar tendon versus semitendinosus and gracilis tendons. Am J Sports Med 19:478–484PubMedCrossRef
15.
go back to reference Marrale J, Morrissey MC, Haddad FS (2007) A literature review of autograft and allograft: anterior ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 15:690–704PubMedCrossRef Marrale J, Morrissey MC, Haddad FS (2007) A literature review of autograft and allograft: anterior ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 15:690–704PubMedCrossRef
16.
go back to reference Ménétrey J, Duthon VB, Laumonier T, Fritschy D (2008) “Biological failure” of the anterior cruciate ligament graft. Knee Surg Sports Traumatol Arthrosc 16:224–231PubMedCrossRef Ménétrey J, Duthon VB, Laumonier T, Fritschy D (2008) “Biological failure” of the anterior cruciate ligament graft. Knee Surg Sports Traumatol Arthrosc 16:224–231PubMedCrossRef
17.
go back to reference Muneta T, Takakuda K, Yamamoto H (1997) Intercondylar notch width and its relation to the configuration and cross-sectional area of the anterior cruciate ligament: a cadaveric knee study. Am J Sports Med 25:69–72PubMedCrossRef Muneta T, Takakuda K, Yamamoto H (1997) Intercondylar notch width and its relation to the configuration and cross-sectional area of the anterior cruciate ligament: a cadaveric knee study. Am J Sports Med 25:69–72PubMedCrossRef
18.
go back to reference Myers P, Logan M, Stokes A, Boyd K, Watts M (2008) Bioabsorbable versus titanium interference screws with hamstring autograft in anterior cruciate ligament reconstruction: a prospective randomized trial with 2-year follow-up. Arthroscopy 24:817–823PubMedCrossRef Myers P, Logan M, Stokes A, Boyd K, Watts M (2008) Bioabsorbable versus titanium interference screws with hamstring autograft in anterior cruciate ligament reconstruction: a prospective randomized trial with 2-year follow-up. Arthroscopy 24:817–823PubMedCrossRef
19.
go back to reference Ng GY, Oakes BW, Deacon OW, McLean ID, Lampard D (1995) Biomechanics of patellar tendon autograft for reconstruction of the anterior cruciate ligament in the goat: 3-year study. J Orthop Res 13:602–608PubMedCrossRef Ng GY, Oakes BW, Deacon OW, McLean ID, Lampard D (1995) Biomechanics of patellar tendon autograft for reconstruction of the anterior cruciate ligament in the goat: 3-year study. J Orthop Res 13:602–608PubMedCrossRef
20.
go back to reference Niki Y, Matsumoto H, Hakozaki A, Kanagawa H, Toyama Y, Suda Y (2011) Anatomic double-bundle anterior cruciate ligament reconstruction using bone-patellar tendon-bone and gracilis tendon graft: a comparative study with 2-year follow-up results of semitendinosus tendon grafts alone or semitendinosus-gracilis tendon grafts. Arthroscopy 27:1242–1251PubMedCrossRef Niki Y, Matsumoto H, Hakozaki A, Kanagawa H, Toyama Y, Suda Y (2011) Anatomic double-bundle anterior cruciate ligament reconstruction using bone-patellar tendon-bone and gracilis tendon graft: a comparative study with 2-year follow-up results of semitendinosus tendon grafts alone or semitendinosus-gracilis tendon grafts. Arthroscopy 27:1242–1251PubMedCrossRef
21.
go back to reference Noyes FR, Grood ES (1976) The strength of the anterior cruciate ligament in humans and Rhesus monkeys. J Bone Joint Surg Am 58:1074–1082PubMed Noyes FR, Grood ES (1976) The strength of the anterior cruciate ligament in humans and Rhesus monkeys. J Bone Joint Surg Am 58:1074–1082PubMed
22.
go back to reference Prodromos C, Joyce B, Shi K (2007) A meta-analysis of stability of autografts compared to allografts after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 15:851–856PubMedCrossRef Prodromos C, Joyce B, Shi K (2007) A meta-analysis of stability of autografts compared to allografts after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 15:851–856PubMedCrossRef
23.
go back to reference Pujol N, Fong O, Karoubi M, Beaufils P, Boisrenoult P (2010) Anatomic double-bundle ACL reconstruction using a bone-patellar tendon-bone autograft: a technical note. Knee Surg Sports Traumatol Arthrosc 18:43–46PubMedCrossRef Pujol N, Fong O, Karoubi M, Beaufils P, Boisrenoult P (2010) Anatomic double-bundle ACL reconstruction using a bone-patellar tendon-bone autograft: a technical note. Knee Surg Sports Traumatol Arthrosc 18:43–46PubMedCrossRef
24.
go back to reference Saddemi SR, Frogameni AD, Fenton PJ, Hartman J, Hartman W (1993) Comparison of perioperative morbidity of anterior cruciate ligament autografts versus allografts. Arthroscopy 9:519–524PubMedCrossRef Saddemi SR, Frogameni AD, Fenton PJ, Hartman J, Hartman W (1993) Comparison of perioperative morbidity of anterior cruciate ligament autografts versus allografts. Arthroscopy 9:519–524PubMedCrossRef
25.
go back to reference Sadoghi P, Kröpfl A, Jansson V, Müller PE, Pietschmann MF, Fischmeister MF (2011) Impact of tibial and femoral tunnel position on clinical results after anterior cruciate ligament reconstruction. Arthroscopy 27:355–364PubMedCrossRef Sadoghi P, Kröpfl A, Jansson V, Müller PE, Pietschmann MF, Fischmeister MF (2011) Impact of tibial and femoral tunnel position on clinical results after anterior cruciate ligament reconstruction. Arthroscopy 27:355–364PubMedCrossRef
26.
go back to reference Shaieb M, Kan D, Chang S, Marumoto J, Richardson A (2002) A prospective randomized comparison of patellar tendon versus semitendinosus and gracilis tendon autografts for anterior cruciate ligament reconstruction. Am J Sports Med 30:214–220PubMed Shaieb M, Kan D, Chang S, Marumoto J, Richardson A (2002) A prospective randomized comparison of patellar tendon versus semitendinosus and gracilis tendon autografts for anterior cruciate ligament reconstruction. Am J Sports Med 30:214–220PubMed
27.
go back to reference Shino K, Nakata K, Horibe S, Inoue M, Nakagawa S (1993) Quantitative evaluation after arthroscopic anterior cruciate ligament reconstruction. Am J Sports Med 4:609–616CrossRef Shino K, Nakata K, Horibe S, Inoue M, Nakagawa S (1993) Quantitative evaluation after arthroscopic anterior cruciate ligament reconstruction. Am J Sports Med 4:609–616CrossRef
28.
go back to reference Sun K, Tian SQ, Zhang JH, Xia CS, Zhang CL, Yu TB (2009) Anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft versus allograft. Arthroscopy 25:750–759PubMedCrossRef Sun K, Tian SQ, Zhang JH, Xia CS, Zhang CL, Yu TB (2009) Anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft versus allograft. Arthroscopy 25:750–759PubMedCrossRef
29.
go back to reference Woo SL, Hollis JM, Adams DJ, Lyon RM, Takai S (1991) Tensile properties of the human femur-anterior cruciate ligament-tibia complex: the effects of specimen age and orientation. Am J Sports Med 19:217–225PubMedCrossRef Woo SL, Hollis JM, Adams DJ, Lyon RM, Takai S (1991) Tensile properties of the human femur-anterior cruciate ligament-tibia complex: the effects of specimen age and orientation. Am J Sports Med 19:217–225PubMedCrossRef
30.
go back to reference Yasuda K, Kondo E, Ichiyama H, Kitamura N, Tanabe Y, Tohyama H, Minami A (2004) Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts. Arthroscopy 20:1015–1025PubMedCrossRef Yasuda K, Kondo E, Ichiyama H, Kitamura N, Tanabe Y, Tohyama H, Minami A (2004) Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts. Arthroscopy 20:1015–1025PubMedCrossRef
31.
go back to reference Yasuda K, Kondo E, Ichiyama H, Tanabe Y, Tohyama H (2006) Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: comparisons among 3 different procedures. Arthroscopy 22:240–251PubMedCrossRef Yasuda K, Kondo E, Ichiyama H, Tanabe Y, Tohyama H (2006) Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: comparisons among 3 different procedures. Arthroscopy 22:240–251PubMedCrossRef
32.
go back to reference Yoshiya S, Kurosaka M, Shoda E, Kuroda R, Shimizu K, Yamamoto T (2003) Cross-sectional area of a bone-patellar tendon-bone graft for anterior cruciate ligament reconstruction. J Knee Surg 16:75–78PubMed Yoshiya S, Kurosaka M, Shoda E, Kuroda R, Shimizu K, Yamamoto T (2003) Cross-sectional area of a bone-patellar tendon-bone graft for anterior cruciate ligament reconstruction. J Knee Surg 16:75–78PubMed
33.
go back to reference Zaffagnini S, Bruni D, Marcheggiani Muccioli GM, Bonanzinga T, Lopomo N, Bignozzi S, Marcacci M (2011) Single-bundle patellar tendon versus non-anatomical double-bundle hamstrings ACL reconstruction: a prospective randomized study at 8-year minimum follow-up. Knee Surg Sports Traumatol Arthrosc 19:390–397PubMedCrossRef Zaffagnini S, Bruni D, Marcheggiani Muccioli GM, Bonanzinga T, Lopomo N, Bignozzi S, Marcacci M (2011) Single-bundle patellar tendon versus non-anatomical double-bundle hamstrings ACL reconstruction: a prospective randomized study at 8-year minimum follow-up. Knee Surg Sports Traumatol Arthrosc 19:390–397PubMedCrossRef
34.
go back to reference Zhao J, He Y, Wang J (2004) Double-bundle anterior cruciate ligament reconstruction: four versus eight strands of hamstring tendon graft. Arthroscopy 23:766–770 Zhao J, He Y, Wang J (2004) Double-bundle anterior cruciate ligament reconstruction: four versus eight strands of hamstring tendon graft. Arthroscopy 23:766–770
Metadata
Title
Arthroscopic single-bundle ACL reconstruction with modified double-layer bone-patellar tendon-bone allograft
Authors
Hui Jun Kang
Yan Ling Su
Hui Jian Cao
Fei Wang
Da Hai Yu
Zhi Min Zheng
Ying Ze Zhang
Publication date
01-09-2013
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2013
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-012-2235-8

Other articles of this Issue 9/2013

Knee Surgery, Sports Traumatology, Arthroscopy 9/2013 Go to the issue