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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 1/2011

01-12-2011 | Knee

A matched pairs comparison of single- versus double-bundle anterior cruciate ligament reconstructions, clinical results and manual laxity testing

Authors: R. Siebold, T. P. Branch, H. I. Freedberg, C. A. Jacobs

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Special Issue 1/2011

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Abstract

Purpose

To compare the subjective clinical results as well as manual anterior and rotational stability in patients treated with either single- (SB) or double-bundle (DB) anterior cruciate ligament (ACL) reconstructions.

Methods

Sixty-four patients who had undergone SB or DB hamstring ACL reconstruction with hamstrings were included in a retrospective matched pair analysis. At follow-up IKDC subjective, CKS, KOOS, CKS and a visual analogue satisfaction scale was assessed. A blinded surgeon examined the joint laxity and completed the objective IKDC. The KT-1000 was used to bilaterally test anterior tibial translation. Patients with confounding variables, which statistically influenced the clinical outcome (passive flexion and extension deficits, persistent quadriceps deficit, tibiofemoral osteoarthritis and non-repairable medial meniscus injury), were identified and excluded from the statistical analysis (n = 10).

Results

For all subjective scores, DB patients reported increased scores compared with SB patients. While consistently higher scores were demonstrated, statistical significance was only achieved for the IKDC subjective (P = 0.04) and VAS satisfaction (P = 0.02). Graded stability results of the Lachman, anterior drawer and pivot-shift tests were significantly higher in the DB group and KT-1000 side-to-side difference was significantly better for DB (P = 0.01).

Conclusion

DB ACL reconstruction appeared to more consistently result in significantly higher subjective outcome scores and manual tests of joint stability than SB ACL reconstruction. Besides the surgical technique, normal extension and quadriceps strength after surgery were identified to be an essential component in order to provide the patient with a successful outcome.

Level of evidence

II.
Literature
1.
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
2.
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
3.
Ahn JH, Lee SH (2007) Anterior cruciate ligament double-bundle reconstruction with hamstring tendon autografts. Arthroscopy 23:109.e1–4
4.
Amis AA, Zavras TD (1995) Isometricity and graft placement during anterior cruciate ligament reconstruction. Knee 2:5–17CrossRef
5.
Araki D, Kuroda R, Kubo S, Fujita N, Tei K, Nishimoto K, Hoshino Y, Matsushita T, Matsumoto T, Nagamune K, Kurosaka M (2011) A prospective randomised study of anatomical single-bundle versus double-bundle anterior cruciate ligament reconstruction: quantitative evaluation using an electromagnetic measurement system. Int Orthop 35:439–446
6.
Bellier G, Christel P, Colombet P, Djian P, Franceschi JP, Sbihi A (2004) Double-stranded hamstring graft for anterior cruciate ligament reconstruction. Arthroscopy 20:890–894PubMedCrossRef
7.
Bernard M, Hertel P, Hornung H, Cierpinski T (1997) Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg 10:14–21PubMed
8.
Branch TP, Siebold R, Freedberg HI, Jacobs CA (2011) Double-bundle ACL reconstruction demonstrated superior clinical stability to single-bundle ACL reconstruction: a matched-pairs analysis of instrumented tests of tibial anterior translation and internal rotation laxity. Knee Surg Sports Traumatol Arthrosc 19:432–440
9.
Buoncristiani AM, Tjoumakaris FP, Starman JS, Ferretti M, Fu FH (2006) Anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 22:1000–1006PubMedCrossRef
10.
Cha PS, Brucker PU, West RV, Zelle BA, Yagi M, Kurosaka M, Fu FH (2005) Arthroscopic double bundle anterior cruciate ligament reconstruction: an anatomic approach. Arthroscopy 21:1275–1277PubMed
11.
Colombet P, Menetrey J, Panisset JC, Société française d’arthroscopie (2008) The effect of the posterolateral bundle in the anterior cruciate ligament reconstruction. Rev Chir Orthop Reparatrice Appar Mot 94:369–371PubMedCrossRef
12.
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
13.
Colombet P, Robinson J, Jambou S, Allard M, Bousquet V, de Lavigne C (2006) Two-bundle, four-tunnel anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 14:629–636PubMedCrossRef
14.
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
15.
Edwards A, Bull AM, Amis AA (2007) The attachments of the anteromedial and posterolateral fibre bundles of the anterior cruciate ligament: part1: tibial attachment. Knee Surg Sports Traumatol Arthrosc 15:1414–1421PubMedCrossRef
16.
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
17.
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
18.
Fu Fh, Shen W, Starman JS, Okeke N, Irrgang JJ (2008) Primary anatomic double-bundle anterior cruciate ligament reconstruction: a preliminary 2-year prospective study. Am J Sports Med 36:1263–1274PubMedCrossRef
19.
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
20.
Goble EM, Downey DJ, Wilcox TR (1995) Positioning of the tibial tunnel for anterior cruciate ligament reconstruction. Arthroscopy 11:688–695PubMedCrossRef
21.
Hamada M, Shino K, Horibe S, Mitsuoka T, Miyama T, Shiozaki Y, Mae T (2001) Single-versus bi-socket anterior cruciate ligament reconstruction using autogenous multiple-stranded hamstring tendons with EndoButton femoral fixation: a prospective study. Arthroscopy 17:801–807PubMed
22.
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
23.
Harner CD, Baek GH, Vogrin TM, Carlin GJ, Kashiwaguchi S, Woo SL (1999) Quantitative analysis of human cruciate ligament insertions. Arthroscopy 15:741–749PubMedCrossRef
24.
Ho JY, Gardiner A, Shah V, Steiner ME (2009) Equal kinematics between central anatomic single-bundle and double-bundle anterior cruciate ligament reconstructions. Arthroscopy 25:464–472PubMedCrossRef
25.
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
26.
Ibrahim SA, Hamido F, Al Misfer AK, Mahgoob A, Ghafar SA, Alhran H (2009) Anterior cruciate ligament reconstruction using autologous hamstring double bundle graft compared with single bundle procedures. J Bone Joint Surg Br 91:1310–1315PubMedCrossRef
27.
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
28.
Jackson DW, Gasser SI (1994) Tibial tunnel placement in ACL reconstruction. Arthroscopy 10:124–131PubMedCrossRef
29.
Järvelä T, Moisala AS, Sihvonen R, Järvelä S, Kannus P, Järvinen M (2008) Double-bundle anterior cruciate ligament reconstruction using hamstring autografts and bioabsorbable interference screw fixation: prospective, randomized, clinical study with 2-year results. Am J Sports Med 36:290–297PubMedCrossRef
30.
Kim SJ, Jo SB, Kumar P, Ks Oh (2009) Comparison of single- and double-bundle anterior cruciate ligament reconstruction using quadriceps tendon-bone autografts. Arthroscopy 25:70–77PubMedCrossRef
31.
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
32.
Marcacci M, Molgora AP, Zaffagnini S, Vascellari A, Iacono F, Presti ML (2003) Anatomic double-bundle anterior cruciate ligament reconstruction with hamstrings. Arthroscopy 19:540–546PubMedCrossRef
33.
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
34.
Mizner R, Snyder-Mackler L (2005) Altered loading during walking and sit-to-stand is affected by quadriceps weakness after total knee arthroplasty. J Orthop Res 23:1083–1090PubMedCrossRef
35.
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
36.
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
37.
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
38.
Muneta T, Koga H, Morito T, Yagishita K, Sekiya I (2006) A retrospective study of the midterm outcome of two-bundle anterior cruciate ligament reconstruction using quadrupled semitendinosus tendon in comparison with one-bundle reconstruction. Arthroscopy 22:252–258PubMedCrossRef
39.
Muneta T, Sekiya I, Yagishita K, Ogiuchi T, Yamamoto H, Shinomiya K (1999) Two-bundle reconstruction of the anterior cruciate ligament using semitendinosus tendon with endobuttons: operative technique and preliminary results. Arthroscopy 15:618–624PubMedCrossRef
40.
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
41.
Musahl V, Bedi A, Citak M, O’Loughlin P, Choi D, Pearle AD (2011) Effect of single-bundle and double-bundle anterior cruciate ligament reconstructions on pivot-shift kinematics in anterior cruciate ligament- and meniscus-deficient knees. Am J Sports Med 39:289–295
42.
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
43.
Park S, Jung YB, Jung HJ, Jung HJ, Shin HK, Kim E, Song KS, Kim GS, Cheon HY, Kim S (2010) Outcome of arthroscopic single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: a preliminary 2-year prospective study. Arthroscopy 26:630–636PubMedCrossRef
44.
Petersen W, Zantop T (2007) Anatomy of the anterior cruciate ligament with regard to its two bundles. Clin Orthop Relat Res 454:35–47PubMedCrossRef
45.
Pombo MW, Shen W, Fu FH (2008) Anatomic double-bundle anterior cruciate ligament reconstruction: where are we today? Arthroscopy 24:1168–1177PubMedCrossRef
46.
Sachs RA, Daniel DM, Stone ML, Garfein RF (1989) Patellofemoral problems after anterior cruciate ligament reconstruction. Am J Sports Med 17:760–765PubMedCrossRef
47.
Sadoghi P, Müller PE, Jansson V, van Griensven M, Kröpfl A, Fischmeister MF (2011) Reconstruction of the anterior cruciate ligament: a clinical comparison of bone-patellar tendon-bone single bundle versus semitendinosus and gracilis double bundle technique. Int Orthop 35:127–133PubMedCrossRef
48.
Sakana M, Fox RJ, Woo SL, Livesay GA, Li G, Fu FH (1997) In situ forces in the anterior cruciate ligament and its bundles in response to anterior tibial loads. J Orthop Res 15:285–293CrossRef
49.
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
50.
Seon JK, Gadikota HR, Wu JL, Sutton K, Gill TJ, Li G (2010) Comparison of single- and double-bundle anterior cruciate ligament reconstructions in restoration of knee kinematics and anterior cruciate ligament forces. Am J Sports Med 38:1359–1367PubMedCrossRef
51.
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
52.
Siebold R, Dehler C, Ellert T (2008) Prospective randomized comparison of double-bundle versus single-bundle anterior cruciate ligament reconstruction. Arthroscopy 24:137–145PubMedCrossRef
53.
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
54.
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
55.
Siebold R, Zantop T (2009) Anatomic double-bundle ACL reconstruction: a call for indications. Knee Surg Sports Traumatol Arthrosc 17:211–212PubMedCrossRef
56.
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 37:1705–1711PubMedCrossRef
57.
Stratford P, Kennedy D (2006) Performance measures were necessary to obtain a complete picture of osteoarthritic patients. J Clin Epidemiol 59:160–167PubMedCrossRef
58.
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
59.
Tashman S, Kopf S, Fu FH (2008) The kinematic basis of ACL reconstruction. Oper Tech Sports Med 16:116–118PubMedCrossRef
60.
Toritsuka Y, Amano H, Kuwano M, Iwai T, Mae T, Ohzono K, Shino K (2009) Outcome of double-bundle ACL reconstruction using hamstring tendons. Knee Surg Sports Traumatol Arthrosc 17:456–463PubMedCrossRef
61.
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
62.
Tsuda E, Ishibashi Y, Fukuda A, Tsukada H, Toh S (2009) Comparable results between lateralized single- and double-bundle ACL reconstructions. Clin Orthop Relat Res 467:1042–1055PubMedCrossRef
63.
van Eck CF, Lesniak BP, Schreiber VM, Fu FH (2010) Anatomic single- and double-bundle anterior cruciate ligament reconstruction flowchart. Arthroscopy 26:258–268PubMedCrossRef
64.
Volpi P, Cervellin M, Denti M, Bait C, Melegati G, Quaglia A, de Girolamo L (2010) ACL reconstruction in sports active people: transtibial DB technique with ST/G vs. transtibial SB technique with BPTB: preliminary results. Injury 41:1168–1171PubMedCrossRef
65.
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
66.
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
67.
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
68.
Yasuda K, Tanabe Y, Kondo E, Kitamura N, Tohyama H (2010) Anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 26:S21–S34PubMedCrossRef
69.
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
70.
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 19:390–397
71.
Zantop T, Diermann N, Schumacher T, Schanz S, Fu FH, Petersen W (2008) Anatomical and non-anatomical double-bundle anterior cruciate ligament reconstruction: importance of femoral tunnel location on knee kinematics. Am J Sports Med 36:678–685PubMedCrossRef
72.
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
73.
Zhao J, Peng X, He Y, Wang J (2006) Two-bundle anterior cruciate ligament reconstruction with eight-stranded hamstring tendons: Four-tunnel technique. Knee 13:36–41PubMedCrossRef
Metadata
Title
A matched pairs comparison of single- versus double-bundle anterior cruciate ligament reconstructions, clinical results and manual laxity testing
Authors
R. Siebold
T. P. Branch
H. I. Freedberg
C. A. Jacobs
Publication date
01-12-2011
Publisher
Springer-Verlag
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue Special Issue 1/2011
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-011-1475-3

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