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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-05-2011 | Knee

The concept of complete footprint restoration with guidelines for single- and double-bundle ACL reconstruction

Author: Rainer Siebold

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 5/2011

Abstract

Purpose

This article introduces guidelines for single- (SB) and double-bundle (DB) ACL reconstruction based on the concept of complete footprint restoration. The goal is to reconstruct a maximum of anterior cruciate ligament (ACL) insertion site area to regain a maximum of ACL function. The concept is based on the hypothesis that the restored biomechanical envelope of the knee is a function of reconstructed ACL insertion site area.

Methods

Individual combinations of graft diameters and drill angles were calculated and matched for all individual insertion site lengths between 8 and 21 mm to maximize the percentage of anatomical footprint restoration. An “insertion site table” was developed to propose individual guidelines during ACL surgery for SB and DB ACL reconstruction based on the intraoperative measurement of the tibial insertion site length.

Results

Our calculations support the use of SB in “small footprints” up to 13 mm, which may restore more than 95% of the native insertion site length. “Intermediate footprints” between 14 and 15 mm may be restored by both a SB or DB ACL reconstruction. For “larger footprints” of 16 mm or more, DB has the potential to replicate 97% or more of the insertion site length which cannot be achieved by a SB ACL reconstruction.

Conclusions

The concept of complete footprint restoration aims to reconstruct a maximum of ACL insertion site area to restore a maximum of functional envelope of the knee. Depending on the individual situation, different surgical approaches (SB/DB), graft diameters and drill angles may apply. An “insertion site table” was designed to give guidelines for SB and DB reconstruction during surgery. According to the new concept, DB ACL reconstruction is only considered as a surgical tool for large footprints and is not indicated for smaller ones.

Adachi N, Ochi M, Uchio Y, Iwasa J, Kuriwaka M, Ito Y (2004) Reconstruction of the anterior cruciate ligament: single- versus double-bundle multistranded hamstring tendons. J Bone Joint Surg Br 86:515–520PubMed

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

Amis AA, Dawkins GPC (1991) Functional anatomy of the anterior cruciate ligament. Fibre bundle actions related to ligament replacements and injuries. J Bone Joint Surg Br 73:260–267PubMed

Arnoczky SP (1983) Anatomy of the anterior cruciate ligament. Clin Orthop Relat Res 172:19–25PubMed

Bach JM, Hull ML (1998) Strain inhomogeneity in the anterior cruciate ligament under application of external and muscular loads. J Biomech Eng 120:497–503PubMedCrossRef

Branch TP, Browne JE, Campbell JD, Siebold R, Freedberg HI, Arendt EA, Lavoie F, Neyret P, Jacobs CA (2010) Rotational laxity greater in patients with anterior cruciate ligament injury than healthy volunteers. Knee Surg Sports Traumatol Arthrosc 18:1379–1384PubMedCrossRef

Brophy RH, Voos JE, Shannon FJ, Granchi CC, Wickiewicz TL, Warren RF, Pearle AD (2008) Changes in the length of virtual anterior cruciate ligament fibers during stability testing: a comparison of conventional single-bundle reconstruction and native anterior cruciate ligament. Am J Sports Med 36:2196–2203PubMedCrossRef

Colombet P, Menetrey J, Panisset JC (2008) Société française d’arthroscopie. The effect of the posterolateral bundle in the anterior cruciate ligament reconstruction. Rev Chir Orthop Reparatrice Appar Mot 94:369–371PubMed

Colombet P, Robinson J, Christel P, Franceschi JP, Djian P, Bellier G, Sbihi A (2006) Morphology of anterior cruciate ligament attachment for anatomic reconstruction: a cadaveric dissection and radiographic study. Arthroscopy 22:984–992PubMedCrossRef

10.

Dodds JA, Arnoczky SP (1994) Anatomy of the anterior cruciate ligament: a blueprint for repair and reconstruction. Arthroscopy 10:132–139PubMedCrossRef

11.

Duthon VB, Barea C, Abrassart S, Fasel JH, Fritschy D, Ménétrey J (2006) Anatomy of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 14:204–213PubMedCrossRef

12.

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

13.

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

14.

Ferretti M, Levicoff EA, Macpherson TA, Moreland MS, Cohen M, Fu FH (2007) The fetal anterior cruciate ligament: an anatomic and histologic study. Arthroscopy 23:278–282PubMedCrossRef

15.

Gabriel MT, Wong EK, Woo SL, Yagi M, Debski RE (2004) Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads. J Orthop Res 22:85–89PubMedCrossRef

16.

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

17.

Giron F, Cuomo P, Aglietti P, Bull AM, Amis AA (2006) Femoral attachment of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 14:250–256PubMedCrossRef

18.

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

19.

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

20.

Harner CD, Baek GH, Vogrin TM, Carlin GJ, Kashiwaguchi S, Woo SL (1999) Quantitative analysis of human cruciate ligament insertions. Arthroscopy 15:741–749PubMedCrossRef

21.

Ho JY, Gardiner A, Shah V, Steiner ME (2010) Equal kinematics between central anatomic single-bundle and double-bundle anterior cruciate ligament reconstructions. Arthroscopy 25:464–472CrossRef

22.

Hofbauer M, Valentin P, Kdolsky R, Ostermann RC, Graf A, Figl M, Aldrian S (2010) Rotational and translational laxity after computer-navigated single- and double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1201–1207PubMedCrossRef

23.

Ishibashi Y, Tsuda E, Fukuda A, Tsukada H, Toh S (2008) Stability evaluation of single-bundle and double-bundle reconstruction during navigated ACL reconstruction. Sports Med Arthrosc 16:77–83PubMedCrossRef

24.

Järvelä T (2007) Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective, randomize clinical study. Knee Surg Sports Traumatol Arthrosc 15:500–507PubMedCrossRef

25.

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 18:2–10

26.

Kondo E, Yasuda K, Azuma H, Tanabe Y, Yagi T (2008) Prospective clinical comparisons of anatomic double-bundle versus single-bundle anterior cruciate ligament reconstruction procedures in 328 consecutive patients. Am J Sports Med 36:1675–1687PubMedCrossRef

27.

Kopf S, Martin DE, Tashman S, Fu FH (2010) Effect of tibial drill angles on bone tunnel aperture during anterior cruciate ligament reconstruction. J Bone Joint Surg Am 92:871–881PubMedCrossRef

28.

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

29.

Meredick RB, Vance KJ, Appleby D, Lubowitz JH (2008) Outcome of single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: a meta-analysis. Am J Sports Med 36:1414–1421PubMedCrossRef

30.

Mochizuki T, Muneta T, Nagase T, Shirasawa S, Akita KI, Sekiya I (2006) Cadaveric knee observation study for describing anatomic femoral tunnel placement for two-bundle anterior cruciate ligament reconstruction. Arthroscopy 22:356–361PubMedCrossRef

31.

Monaco E, Labianca L, Conteduca F, De Carli A, Ferretti A (2007) Double bundle or single bundle plus extraarticular tenodesis in ACL reconstruction? A CAOS study. Knee Surg Sports Traumatol Arthrosc 15:1168–1174PubMedCrossRef

32.

Morimoto Y, Ferretti M, Ekdahl M, Smolinski P, Fu FH (2009) Tibiofemoral joint contact area and pressure after single-bundle and double-bundle anterior cruciate ligament reconstruction. Arthroscopy 25:62–69PubMedCrossRef

33.

Muneta T, Koga H, Mochizuki T, Ju YJ, Hara K, Nimura A, Yagishita K, Sekiya I (2007) A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques. Arthroscopy 23:618–628PubMedCrossRef

34.

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

35.

Odensten M, Gillquist J (1985) Functional anatomy of the anterior cruciate ligament and a rationale for reconstruction. J Bone Joint Surg Am 67:257–262PubMed

36.

Otsubo H, Shino K, Nakamura N, Nakata K, Nakagawa S, Koyanagi M (2007) Arthroscopic evaluation of ACL grafts reconstructed with the anatomical two-bundle technique using hamstring tendon autograft. Knee Surg Sports Traumatol Arthrosc 15:720–728PubMedCrossRef

37.

Paessler HH (1995) Anatomical reconstruction of the anterior cruciate ligament with a patellar tendon autograft using a miniarthrotomy technique. In: Szabo Z, Kerstein M, Lewis JE (eds) Surgical technology international III. Universal Medical Press, INC, San Francisco

38.

Pernin J, Verdonk P, Si Selmi TA, Massin P, Neyret P (2010) Long-term follow-up of 24.5 years after intra-articular anterior cruciate ligament reconstruction with lateral extra-articular augmentation. Am J Sports Med 38:1094–1102PubMedCrossRef

39.

Petersen W, Zantop T (2007) Anatomy of the anterior cruciate ligament with regard to its two bundles. Clin Orthop Relat Res 454:35–47PubMedCrossRef

40.

Pombo MW, Shen W, Fu FH (2008) Anatomic double-bundle anterior cruciate ligament reconstruction: where are we today? Arthroscopy 24:1168–1177PubMedCrossRef

41.

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

42.

Robinson J, Stanford FC, Kendoff D, Stüber V, Pearle AD (2009) Replication of the range of native anterior cruciate ligament fiber length change behavior achieved by different grafts: measurement using computer-assisted navigation. Am J Sports Med 37:1406–1441PubMedCrossRef

43.

Sahasrabudhe A, Christel P, Anne F, Appleby D, Basdekis G (2010) Postoperative evaluation of tibial footprint and tunnels charecteristics characteristics after anatomic double-bundle anterior cruciate ligament reconstruction with anatomic aimers. Knee Surg Sports Traumatol Arthrosc 18:1599–1606PubMedCrossRef

44.

Shino K, Nakata K, Nakamura N, Toritsuka Y, Horibe S, Nakagawa S, Suzuki T (2008) Rectangular tunnel double-bundle anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft to mimic natural fiber arrangement. Arthroscopy 24:1178–1183PubMedCrossRef

45.

Siebold R, Dehler C, Ellert T (2008) Prospective randomized comparison of double-bundle versus single-bundle anterior cruciate ligament reconstruction. Arthroscopy 24:137–145PubMedCrossRef

46.

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

47.

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

48.

Siebold R, Zantop T (2009) Anatomic double-bundle ACL reconstruction: a call for indications. Knee Surg Sports Traumatol Arthrosc 17:211–212PubMedCrossRef

49.

Streich NA, Friedrich K, Gotterbarm T, Schmitt H (2008) Reconstruction of the ACL with a semitendinosus tendon graft: a prospective randomized single blinded comparison of double-bundle versus single-bundle technique in male athletes. Knee Surg Sports Traumatol Arthrosc 16:232–238PubMedCrossRef

50.

Takeda Y, Sato R, Ogawa T, Fujii K, Naruse A (2009) In vivo magnetic resonance imaging measurement of tibiofemoral relation with different knee flexion angles after single- and double-bundle anterior cruciate ligament reconstructions. Arthroscopy 25:733–741PubMedCrossRef

51.

Tashman S, Kopf S, Fu FH (2008) The kinematic basis of ACL reconstruction. Oper Tech Sports Med 16:116–118PubMedCrossRef

52.

Tsai AG, Wijdicks CA, Walsh MP, Laprade RF (2010) Comparative kinematic evaluation of all-inside single-bundle and double-bundle anterior cruciate ligament reconstruction: a biomechanical study. Am J Sports Med 38:263–272PubMedCrossRef

53.

van Eck CF, Lesniak BP, Schreiber VM, Fu FH (2010) Anatomic single- and double-bundle anterior cruciate ligament reconstruction flowchart. Arthroscopy 26:258–268PubMedCrossRef

54.

van Eck CF, Schreiber VM, Liu TT, Fu FH (2010) The anatomic approach to primary, revision and augmentation anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1154–1163PubMedCrossRef

55.

Woo SL, Debski RE, Withrow JD, Janaushek MA (1999) Biomechanics of the knee ligaments. Am J Sports Med 27:533–543PubMed

56.

Wu C, Noorani S, Vercillo F, Woo SL (2009) Tension patterns of the anteromedial and posterolateral grafts in a double-bundle anterior cruciate ligament reconstruction. J Orthop Res 27:879–884PubMedCrossRef

57.

Wu JL, Seon JK, Gadikota HR, Hosseini A, Sutton KM, Gill TJ, Li G (2010) In situ forces in the anteromedial and posterolateral bundles of the anterior cruciate ligament under simulated functional loading conditions. Am J Sports Med 38:558–563PubMedCrossRef

58.

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 30:660–666PubMed

59.

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

60.

Zaffagnini S, Bruni D, Russo A, Takazawa Y, Lo Presti M, Giordano G, Marcacci M (2008) ST/G ACL reconstruction: double strand plus extra-articular sling vs double bundle, randomized study at 3-year follow-up. Scand J Med Sci Sports 18:573–581PubMedCrossRef

61.

Zaffagnini S, Bruni D, Marcheggiani Muccioli GM, Bonanzinga T, Lopomo N, Bignozzi S, Marcacci M (2010) 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 PMID: 20668835

62.

Zantop T, Herbort M, Raschke MJ, Fu FH, Petersen W (2007) The role of the anteromedial and posterolateral bundles of the anterior cruciate ligament in anterior tibial translation and internal rotation. Am J Sports Med 35:223–227PubMedCrossRef

63.

Zantop T, Petersen W, Sekiya JK, Musahl V, Fu FH (2006) ACL anatomy and function relating to anatomical reconstruction. Knee Surg Sports Traumatol Arthrosc 14:982–992PubMedCrossRef

Title: The concept of complete footprint restoration with guidelines for single- and double-bundle ACL reconstruction
Author: Rainer Siebold
Publication date: 01-05-2011
Publisher: Springer-Verlag
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 5/2011
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-010-1376-x

At a glance: The STEP trials

Springer Medicine

The concept of complete footprint restoration with guidelines for single- and double-bundle ACL reconstruction

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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