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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-03-2013 | Knee

Comparison of tunnel placements and clinical results of single-bundle anterior cruciate ligament reconstruction before and after starting the use of double-bundle technique

Authors: Piia Suomalainen, Anna-Stina Moisala, Antti Paakkala, Pekka Kannus, Timo Järvelä

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2013

Abstract

Purpose

To investigate whether the locations of the grafts in single-bundle (SB) anterior cruciate ligament (ACL) reconstruction have changed to more anatomical as the double-bundle (DB) method has become more familiar.

Methods

Operation using anteromedial (not transtibial) portal and freehand technique [Group A (N = 25) in 2003, Group B (N = 25) in 2007]. The evaluation methods preoperatively and at the 2-year follow-up (two blinded examiners): clinical examination, stability measurement (KT-1000 arthrometer), the International Knee Documentation Committee (IKDC), and the Lysholm knee scores. A musculoskeletal radiologist made tunnel measurements from the magnetic resonance imaging (MRI).

Results

The average tunnel placement in the femoral side: from Blumensaat’s line 27 % (Group A) and 26 % (Group B), from the posterior edge of the femur 32 % (Group A) and 29 % (Group B). The average tunnel placement in the tibial side: from the anterior edge 45 % (Group A) and 45 % (Group B), from the lateral side 57 % (Group A) and 54 % (Group B) (P = 0.024). Graft failures ending up to revision ACL surgery: 4 (Group A) and 0 (Group B) (P = 0.045). Operation time reduced 19 min (P = 0.001).

Conclusion

Tunnel placement at the femoral side was already very low (anatomical) in patients operated in 2003. No significant difference was found when comparing to the patients operated in 2007. There were significantly more graft failures in the Group A, suggesting that the use of the DB method in ACL surgery in 2007 may have also improved the technique and results of the SB ACL reconstruction.

Level of evidence

Prospective comparative study, Level II.

Ahn JH, Lee SH, Choi SH, Lim TK (2010) Magnetic resonance imaging evaluation of anterior cruciate ligament reconstruction using quadrupled hamstring tendon autografts: comparison of remnant bundle preservation and standard technique. Am J Sports Med 38:1768–1777PubMedCrossRef

Bedi A, Raphael B, Maderazo A, Pavlov H, Williams RJ 3rd (2010) Transtibial versus anteromedial portal drilling for anterior cruciate ligament reconstruction: a cadaveric study of femoral tunnel length and obliquity. Arthroscopy 26:342–350PubMedCrossRef

Bedi A, Musahl V, Steuber V, Kendoff D, Choi D, Allen AA, Pearle AD, Altchek DW (2011) Transtibial versus anteromedial portal reaming in anterior cruciate ligament reconstruction: an anatomic and biomechanical evaluation of surgical technique. Arthroscopy 27:380–390PubMedCrossRef

Bicer EK, Lustig S, Servien E, Selmi TA, Neyret P (2010) Current knowledge in the anatomy of the human anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 18:1075–1084PubMedCrossRef

Bonsell S (2000) Financial analysis of anterior cruciate ligament reconstruction at Baylor University Medical Center. Proc (Bayl Univ Med Cent) 13:327–330

Bowers AL, Bedi A, Lipman JD, Potter HG, Rodeo SA, Pearle AD, Warren RF, Altchek DW (2011) Comparison of anterior cruciate ligament tunnel position and graft obliquity with transtibial and anteromedial portal femoral tunnel reaming techniques using high-resolution magnetic resonance imaging. Arthroscopy 27:1511–1522PubMedCrossRef

Casagranda B, Maxwell N, Kavanagh E, Towers J, Shen W, Fu F (2009) Normal appearance and complications of double-bundle and selective-bundle anterior cruciate ligament reconstructions using optimal MRI techniques. Am J Roentgenol 192:1407–1415CrossRef

van Eck CF, Schreiber VM, Mejia HA, Samuelsson K, van Dijk CN, Karlsson J, Fu FH (2010) “Anatomic” anterior cruciate ligament reconstruction: a systematic review of surgical techniques and reporting of surgical data. Arthroscopy 26(suppl):S2–S12PubMed

Edwards A, Bull AM, Amis AA (2007) The attachments of the anteromedial and posterolateral fibre bundles of the anterior cruciate ligament. Part 1: tibial attachment. Knee Surg Sports Traumatol Arthrosc 15:1414–1421PubMedCrossRef

10.

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 16:29–36PubMedCrossRef

11.

Ferretti M, Ekdahl M, Shen W, Fu FH (2007) Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy 23:1218–1225PubMedCrossRef

12.

Gadikota HR, Wu JL, Seon JK, Sutton K, Gill TJ, Li G (2010) Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft: can it restore normal knee joint kinematics? Am J Sports Med 38:713–720PubMedCrossRef

13.

Griffin LY, Agel J, Albohm MJ, Arendt EA, Dick RW, Garrett WE et al (2000) Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg 8:141–150PubMed

14.

Hara K, Mochizuki T, Sekiya I, Yamaguchi K, Akita K, Muneta T (2009) Anatomy of normal human anterior cruciate ligament attachments evaluated by divided small bundles. Am J Sports Med 37:2386–2391PubMedCrossRef

15.

Hohmann E, Bryant A, Tetsworth K (2010) Tunnel positioning in anterior cruciate ligament reconstruction: how long is the learning curve? Knee Surg Sports Traumatol Arthrosc 18:1576–1582PubMedCrossRef

16.

Iriuchishima T, Ingham SJ, Tajima G, Horaguchi T, Saito A, Tokuhashi Y, Van Houten AH, Aerts MM, Fu FH (2010) Evaluation of the tunnel placement in the anatomical double-bundle ACL reconstruction: a cadaver study. Knee Surg Sports Traumatol Arthrosc 18:1226–1231PubMedCrossRef

17.

Jarvela T, Suomalainen P (2011) ACL reconstruction with double-bundle technique: a review of clinical results. Phys Sportsmed 39:85–92PubMedCrossRef

18.

Kawakami Y, Hiranaka T, Matsumoto T, Hida Y, Fukui T, Uemoto H, Doita M, Tsuji M, Kurosaka M, Kuroda R (2011) The accuracy of bone tunnel position using fluoroscopic-based navigation system in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc (Epub Oct 22)

19.

Kijowski R, Davis KW, Woods MA, Lindstrom MJ, De Smet AA, Gold GE, Busse RF (2009) Knee joint: comprehensive assessment with 3D isotropic resolution fast spin-echo MR imaging–diagnostic performance compared with that of conventional MR imaging at 3.0 T. Radiology 252:486–495PubMedCrossRef

20.

Kopf S, Musahl V, Tashman S, Szczodry M, Shen W, Fu FH (2009) A systematic review of the femoral origin and tibial insertion morphology of the ACL. Knee Surg Sports Traumatol Arthrosc 17:213–219PubMedCrossRef

21.

Lorenz S, Elser F, Mitterer M, Obst T, Imhoff AB (2009) Radiologic evaluation of the insertion sites of the 2 functional bundles of the anterior cruciate ligament using 3-dimensional computed tomography. Am J Sports Med 37:2368–2376PubMedCrossRef

22.

Miller MD, Gerdeman AC, Miller CD, Hart JM, Gaskin CM, Golish SR, Clancy WG Jr (2010) The effects of extra-articular starting point and transtibial femoral drilling on the intra-articular aperture of the tibial tunnel in ACL reconstruction. Am J Sports Med 38:707–712PubMedCrossRef

23.

Musahl V, Voos JE, O’Loughlin PF, Choi D, Stueber V, Kendoff D, Pearle AD (2010) Comparing stability of different single- and double-bundle anterior cruciate ligament reconstruction techniques: a cadaveric study using navigation. Arthroscopy 26:S41–S48PubMedCrossRef

24.

Nagda SH, Altobelli GG, Bowdry KA, Brewster CE, Lombardo SJ (2010) Cost analysis of outpatient anterior cruciate ligament reconstruction: autograft versus allograft. Clin Orthop Relat Res 468:1418–1422PubMedCrossRef

25.

Samuelsson K, Andersson D, Karlsson J (2009) Treatment of anterior cruciate ligament injuries with special reference to graft type and surgical technique: an assessment of randomized controlled trials. Arthroscopy 25:1139–1174PubMedCrossRef

26.

Sastre S, Popescu D, Núñez M, Pomes J, Tomas X, Peidro L (2010) Double-bundle versus single-bundle ACL reconstruction using the horizontal femoral position: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 18:32–36PubMedCrossRef

27.

Siebold R, Ellert T, Metz S, Metz J (2008) Femoral insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: morphometry and arthroscopic orientation models for double-bundle bone tunnel placement—a cadaver study. Arthroscopy 24:585–592PubMedCrossRef

28.

Siebold R, Ellert T, Metz S, Metz J (2008) Tibial insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: morphometry, arthroscopic landmarks, and orientation model for bone tunnel placement. Arthroscopy 24:154–161PubMedCrossRef

29.

Snow M, Stanish WD (2010) Double-bundle ACL reconstruction: how big is the learning curve? Knee Surg Sports Traumatol Arthrosc 18:1195–1200PubMedCrossRef

30.

Steckel H, Musahl V, Fu FH (2010) The femoral insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: a radiographic evaluation. Knee Surg Sports Traumatol Arthrosc 18:52–55PubMedCrossRef

31.

Steiner M (2009) Anatomic single-bundle ACL reconstruction. Sports Med Arthrosc 17:247–251PubMedCrossRef

32.

Suomalainen P, Moisala AS, Paakkala A, Kannus P, Järvelä T (2011) Double-bundle versus single-bundle anterior cruciate ligament reconstruction: randomized clinical and magnetic resonance imaging study with 2-year follow-up. Am J Sports Med 39:1615–1622PubMedCrossRef

33.

Xu Y, Ao Y, Wang J, Yu J, Cui G (2011) Relation of tunnel enlargement and tunnel placement after single-bundle anterior cruciate ligament reconstruction. Arthroscopy 27:923–932PubMedCrossRef

34.

Yamazaki J, Muneta T, Koga H, Sekiya I, Ju YJ, Morito T, Yagishita K (2011) Radiographic description of femoral tunnel placement expressed as intercondylar clock time in double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 19:418–423PubMedCrossRef

Title: Comparison of tunnel placements and clinical results of single-bundle anterior cruciate ligament reconstruction before and after starting the use of double-bundle technique
Authors: Piia Suomalainen
Anna-Stina Moisala
Antti Paakkala
Pekka Kannus
Timo Järvelä
Publication date: 01-03-2013
Publisher: Springer-Verlag
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2013
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-012-1981-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison of tunnel placements and clinical results of single-bundle anterior cruciate ligament reconstruction before and after starting the use of double-bundle technique

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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