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Knee Surgery, Sports Traumatology, Arthroscopy

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Open Access 01-12-2017 | Knee

Double-bundle anterior cruciate ligament reconstruction is superior to single-bundle reconstruction in terms of revision frequency: a study of 22,460 patients from the Swedish National Knee Ligament Register

Authors: Eleonor Svantesson, David Sundemo, Eric Hamrin Senorski, Eduard Alentorn-Geli, Volker Musahl, Freddie H. Fu, Neel Desai, Anders Stålman, Kristian Samuelsson

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2017

Abstract

Purpose

Studies comparing single- and double-bundle anterior cruciate ligament (ACL) reconstructions often include a combined analysis of anatomic and non-anatomic techniques. The purpose of this study was to compare the revision rates between single- and double-bundle ACL reconstructions in the Swedish National Knee Ligament Register with regard to surgical variables as determined by the anatomic ACL reconstruction scoring checklist (AARSC).

Methods

Patients from the Swedish National Knee Ligament Register who underwent either single- or double-bundle ACL reconstruction with hamstring tendon autograft during the period 2007–2014 were included. The follow-up period started with primary ACL reconstruction, and the outcome measure was set as revision surgery. An online questionnaire based on the items of the AARSC was used to determine the surgical technique implemented in the single-bundle procedures. These were organized into subgroups based on surgical variables, and the revision rates were compared with the double-bundle ACL reconstruction. Hazard ratios (HR) with 95% confidence interval (CI) was calculated and adjusted for confounders by Cox regression.

Results

A total of 22,460 patients were included in the study, of which 21,846 were single-bundle and 614 were double-bundle ACL reconstruction. Double-bundle ACL reconstruction had a revision frequency of 2.0% (n = 12) and single-bundle 3.2% (n = 689). Single-bundle reconstruction had an increased risk of revision surgery compared with double-bundle [adjusted HR 1.98 (95% CI 1.12–3.51), p = 0.019]. The subgroup analysis showed a significantly increased risk of revision surgery in patients undergoing single-bundle with anatomic technique using transportal drilling [adjusted HR 2.51 (95% CI 1.39–4.54), p = 0.002] compared with double-bundle ACL reconstruction. Utilizing a more complete anatomic technique according to the AARSC lowered the hazard rate considerably when transportal drilling was performed but still resulted in significantly increased risk of revision surgery compared with double-bundle ACL reconstruction [adjusted HR 1.87 (95% CI 1.04–3.38), p = 0.037].

Conclusions

Double-bundle ACL reconstruction is associated with a lower risk of revision surgery than single-bundle ACL reconstruction. Single-bundle procedures performed using transportal femoral drilling technique had significantly higher risk of revision surgery compared with double-bundle. However, a reference reconstruction with transportal drilling defined as a more complete anatomic reconstruction reduces the risk of revision surgery considerably.

Level of evidence

III.

Araujo PH, Asai S, Pinto M, Protta T, Middleton K, Linde-Rosen M, Irrgang J, Smolinski P, Fu FH (2015) ACL graft position affects in situ graft force following acl reconstruction. J Bone Joint Surg Am 97(21):1767–1773CrossRefPubMed

Bjornsson H, Andernord D, Desai N, Norrby O, Forssblad M, Petzold M, Karlsson J, Samuelsson K (2015) No difference in revision rates between single- and double-bundle anterior cruciate ligament reconstruction: a comparative study of 16,791 patients from the Swedish national knee ligament register. Arthroscopy 31(4):659–664CrossRefPubMed

Bjornsson H, Desai N, Musahl V, Alentorn-Geli E, Bhandari M, Fu F, Samuelsson K (2015) Is double-bundle anterior cruciate ligament reconstruction superior to single-bundle? a comprehensive systematic review. Knee Surg Sports Traumatol Arthrosc 23(3):696–739CrossRefPubMed

Desai N (2016) Anatomic anterior cruciate ligament reconstruction-aspects of surgical technique. Doctoral thesis, Sahlgrenska Academy, University of Gothenburg. http://hdl.handle.net/2077/41829, ISBN: 978-91-628-9625-6

Desai N, Alentorn-Geli E, van Eck CF, Musahl V, Fu FH, Karlsson J, Samuelsson K (2016) A systematic review of single- versus double-bundle ACL reconstruction using the anatomic anterior cruciate ligament reconstruction scoring checklist. Knee Surg Sports Traumatol Arthrosc 24(3):862–872CrossRefPubMed

Emilsson L, Lindahl B, Koster M, Lambe M, Ludvigsson JF (2015) Review of 103 Swedish healthcare quality registries. J Intern Med 277(1):94–136CrossRefPubMed

Girgis FG, Marshall JL, Monajem A (1975) The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop Relat Res 106:216–231CrossRef

Hofbauer M, Muller B, Murawski CD, Baraga M, van Eck CF, Fu FH (2013) Strategies for revision surgery after primary double-bundle anterior cruciate ligament (ACL) reconstruction. Knee Surg Sports Traumatol Arthrosc 21(9):2072–2080CrossRefPubMed

Hofbauer M, Murawski CD, Muller B, van Eck CF, Fu FH (2014) Revision surgery after primary double-bundle ACL reconstruction: aAOS exhibit selection. J Bone Joint Surg Am 96(4):e30CrossRefPubMed

10.

Karlsson J, Irrgang JJ, van Eck CF, Samuelsson K, Mejia HA, Fu FH (2011) Anatomic single- and double-bundle anterior cruciate ligament reconstruction, part 2: clinical application of surgical technique. Am J Sports Med 39(9):2016–2026CrossRefPubMed

11.

Kato Y, Ingham SJ, Kramer S, Smolinski P, Saito A, Fu FH (2010) Effect of tunnel position for anatomic single-bundle ACL reconstruction on knee biomechanics in a porcine model. Knee Surg Sports Traumatol Arthrosc 18(1):2–10CrossRefPubMed

12.

Kondo E, Merican AM, Yasuda K, Amis AA (2011) Biomechanical comparison of anatomic double-bundle, anatomic single-bundle, and nonanatomic single-bundle anterior cruciate ligament reconstructions. Am J Sports Med 39(2):279–288CrossRefPubMed

13.

Kongtharvonskul J, Attia J, Thamakaison S, Kijkunasathian C, Woratanarat P, Thakkinstian A (2013) Clinical outcomes of double- vs single-bundle anterior cruciate ligament reconstruction: a systematic review of randomized control trials. Scand J Med Sci Sports 23(1):1–14CrossRefPubMed

14.

Kopf S, Forsythe B, Wong AK, Tashman S, Anderst W, Irrgang JJ, Fu FH (2010) Nonanatomic tunnel position in traditional transtibial single-bundle anterior cruciate ligament reconstruction evaluated by three-dimensional computed tomography. J Bone Joint Surg Am 92(6):1427–1431CrossRefPubMedPubMedCentral

15.

Kvist J, Kartus J, Karlsson J, Forssblad M (2014) Results from the Swedish national anterior cruciate ligament register. Arthroscopy 30(7):803–810CrossRefPubMed

16.

Lubowitz JH (2014) Anatomic ACL reconstruction produces greater graft length change during knee range-of-motion than transtibial technique. Knee Surg Sports Traumatol Arthrosc 22(5):1190–1195CrossRefPubMed

17.

Mascarenhas R, Cvetanovich GL, Sayegh ET, Verma NN, Cole BJ, Bush-Joseph C, Bach BR Jr (2015) Does double-bundle anterior cruciate ligament reconstruction improve postoperative knee stability compared with single-bundle techniques? A systematic review of overlapping meta-analyses. Arthroscopy 31(6):1185–1196CrossRefPubMed

18.

Rahr-Wagner L, Thillemann TM, Pedersen AB, Lind MC (2013) Increased risk of revision after anteromedial compared with transtibial drilling of the femoral tunnel during primary anterior cruciate ligament reconstruction: results from the Danish knee ligament reconstruction register. Arthroscopy 29(1):98–105CrossRefPubMed

19.

Song EK, Oh LS, Gill TJ, Li G, Gadikota HR, Seon JK (2009) Prospective comparative study of anterior cruciate ligament reconstruction using the double-bundle and single-bundle techniques. Am J Sports Med 37(9):1705–1711CrossRefPubMedPubMedCentral

20.

Suomalainen P, Jarvela T, Paakkala A, Kannus P, Jarvinen M (2012) Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective randomized study with 5-year results. Am J Sports Med 40(7):1511–1518CrossRefPubMed

21.

Suomalainen P, Moisala AS, Paakkala A, Kannus P, Jarvela 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(8):1615–1622CrossRefPubMed

22.

Tiamklang T, Sumanont S, Foocharoen T, Laopaiboon M (2012) Double-bundle versus single-bundle reconstruction for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev 11:Cd008413PubMed

23.

van Eck CF, Gravare-Silbernagel K, Samuelsson K, Musahl V, van Dijk CN, Karlsson J, Irrgang JJ, Fu FH (2013) Evidence to support the interpretation and use of the anatomic anterior cruciate ligament reconstruction checklist. J Bone Joint Surg Am 95(20):e153CrossRefPubMed

24.

van Eck CF, Kopf S, Irrgang JJ, Blankevoort L, Bhandari M, Fu FH, Poolman RW (2012) Single-bundle versus double-bundle reconstruction for anterior cruciate ligament rupture: a meta-analysis–does anatomy matter? Arthroscopy 28(3):405–424CrossRefPubMed

25.

van Eck CF, Samuelsson K, Vyas SM, van Dijk CN, Karlsson J, Fu FH (2011) Systematic review on cadaveric studies of anatomic anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 19(Suppl 1):101–108PubMedCentral

26.

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(9 Suppl):S2–12PubMed

27.

Woo SL, Kanamori A, Zeminski J, Yagi M, Papageorgiou C, Fu FH (2002) The effectiveness of reconstruction of the anterior cruciate ligament with hamstrings and patellar tendon. A cadaveric study comparing anterior tibial and rotational loads. J Bone Joint Surg Am 84(6):907–914CrossRefPubMed

28.

Yagi M, Wong EK, Kanamori A, Debski RE, Fu FH, Woo SL (2002) Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med 30(5):660–666CrossRefPubMed

29.

Zelle BA, Vidal AF, Brucker PU, Fu FH (2007) Double-bundle reconstruction of the anterior cruciate ligament: anatomic and biomechanical rationale. J Am Acad Orthop Surg 15(2):87–96CrossRefPubMed

Title: Double-bundle anterior cruciate ligament reconstruction is superior to single-bundle reconstruction in terms of revision frequency: a study of 22,460 patients from the Swedish National Knee Ligament Register
Authors: Eleonor Svantesson
David Sundemo
Eric Hamrin Senorski
Eduard Alentorn-Geli
Volker Musahl
Freddie H. Fu
Neel Desai
Anders Stålman
Kristian Samuelsson
Publication date: 01-12-2017
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2017
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-016-4387-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Double-bundle anterior cruciate ligament reconstruction is superior to single-bundle reconstruction in terms of revision frequency: a study of 22,460 patients from the Swedish National Knee Ligament Register

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

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