Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-08-2009 | Arthroscopy and Sports Medicine

Femoral bridge stability in double-bundle ACL reconstruction: impact of bridge width and different fixation techniques on the structural properties of the graft/femur complex

Authors: Ann-Kristin Lehmann, Nani Osada, Thore Zantop, Michael J. Raschke, Wolf Petersen

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 8/2009

Abstract

Background

The aim of this study was to evaluate the impact of different widths of the bony bridge between the femoral AM and PL bundle tunnel and different fixation techniques on the structural properties of the graft/femur complex in double-bundle ACL reconstructions.

Hypothesis

Double-bundle ACL reconstruction with a bony bridge between AM and PL bundle tunnel of 1 mm results in significantly lower structural properties of the graft/femur complex when compared to a bridge of 2 and 3 mm. Interference screw fixation significantly lowers the structural properties when compared to cortical fixation.

Study design

Controlled laboratory study.

Methods

Double-bundle ACL reconstructions using different bridge widths (1 mm, 2 mm, and 3 mm bridge) were loaded to failure after a cyclic loading protocol (1,000 cycles 0–200 N) and the structural properties were compared to a single-bundle ACL reconstruction group (n = 10 in each group). The structural properties of using a cortical button fixation were then compared to interference screw fixation (2 mm bridge). Statistical analyses were performed using a Mann–Whitney test (P < 0.05).

Results

Double-bundle reconstructions with cortical button fixation (1, 2, and 3 mm bridge) showed significantly higher ultimate failure loads and stiffness and significantly lower elongation compared to single-bundle reconstructions. Double-bundle ACL reconstructions with a 1 mm bridge showed significantly reduced structural properties of the graft/femur complex compared to a 2 or 3 mm bridge. Aperture fixation led to significantly lower ultimate loads when compared to cortical fixation.

Conclusion

The bony bridge between the two femoral tunnels in double-bundle ACL reconstructions influences the stability of the graft/femur complex. Aperture fixation using interference screws shows inferior results when compared to cortical fixation.

Clinical relevance

The results suggest that the indication for anatomical ACL reconstruction may include the size of the lateral femoral condyle. In small knees, a second femoral tunnel may be difficult to locate with a minimum bridge width of 2 mm.

Aglietti P, Giron F, Cuomo P, Losco M, Mondanelli N (2007) Single and double-incision double-bundle ACL reconstruction. Clin Orthop Relat Res 454:108–113PubMedCrossRef

Beynnon BD, Johnson RJ, Abate JA, Fleming BC, Nichols CE (2005) Treatment of anterior cruciate ligament injuries, part I. Am J Sports Med 33(10):1579–1602PubMedCrossRef

Brucker PU, Lorenz S, Imhoff AB (2006) Aperture fixation in arthroscopic anterior cruciate ligament double-bundle reconstruction. Arthroscopy 22(11):1250–1256PubMed

Butler DL (1989) Kappa delta award paper. Anterior cruciate ligament: its normal response and replacement. J Orthop Res 7(6):910–921PubMedCrossRef

Chhabra A, Starman JS, Ferretti M, Vidal AF, Zantop T, Fu FH (2006) Anatomic, radiographic, biomechanical, and kinematic evaluation of the anterior cruciate ligament and its two functional bundles. J Bone Joint Surg Am 88:2–10PubMedCrossRef

Dandy DJ (1981) Arthroscopic surgery of the knee. Churchill Livingstone, Edinburgh London New York, pp 67–68

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

Harner CD, Poehling GG (2004) Double bundle or double trouble? Arthroscopy 20(10):1013–1014PubMed

Järvelä T (2007) Double-bundle versus single-bundle anterior cruciate reconstruction: a prospective, randomize clinical study. Knee Surg Sports Traumatol Arthrosc 15(5):500–507PubMedCrossRef

10.

Mithoefer K, Gill TJ, Vrahas MS (2005) Supracondylar femoral fracture after arthroscopic reconstruction of the anterior cruciate ligament. A case report. J Bone Joint Surg Am 87:1591–1596PubMedCrossRef

11.

Nagarkatti DG, McKeon BP, Donahue BS (2001) Mechanical evaluation of a soft tissue interference screw in free tendon anterior cruciate ligament graft fixation. Am J Sports Med 29:67–71PubMed

12.

Palmer I (1938) On the injuries of the ligaments of the knee joint: a clinical study. Acta chirur scand 91:1–282

13.

Petersen W, Tillmann B (2002) Anatomy and function of the anterior cruciate ligament. Orthopäde 31:710–718PubMedCrossRef

14.

Petersen W, Tretow H, Weimann A, Herbort M, Fu FH, Raschke M, Zantop T (2007) Biomechanical evaluation of two techniques for double-bundle anterior cruciate ligament reconstruction: one tibial tunnel versus two tibial tunnels. Am J Sports Med 35:228–234PubMedCrossRef

15.

Petersen W, Zantop T (2007) Clinical anatomy of the ACL with regard to its two bundles. Clin Orthop Relat Res 454:35–47PubMedCrossRef

16.

Siebold R (2007) Observations on bone tunnel enlargement after double-bundle anterior cruciate ligament reconstruction. Arthroscopy 23(3):291–298PubMed

17.

Singhatat W, Lawhorn KW, Howell SM, Hull ML (2002) How four weeks of implantation affect the strength and stiffness of a tendon graft in a bone tunnel: a study of two fixation devices in an extraarticular model in ovine. Am J Sports Med 30(4):506–513PubMed

18.

Weiler A, Hoffmann RFG, Bail HJ, Rehm O, Südkamp NP (2002) Tendon healing in a bone tunnel. Part II: histologic analysis after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep. Arthroscopy 18(2):124–135PubMedCrossRef

19.

Xerogeanes JW, Fox RJ, Takeda Y, Kim HS, Ishibashi Y, Carlin GJ, Woo SL (1998) A functional comparison of animal anterior cruciate ligament models to the human anterior cruciate ligament. An Biomed Eng 26:345–352CrossRef

20.

Yagi M, Kuroda R, Nagamune K, Yoshida S, Kurosaka M (2007) Double-bundle ACL reconstruction can improve rotational stability. Clin Orthop Relat Res 454:100–107PubMedCrossRef

21.

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

22.

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(3):240–251PubMed

23.

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(2):223–227PubMedCrossRef

24.

Zantop T, Kubo S, Petersen W, Musahl V, Fu FH (2007) Current techniques in anatomic anterior cruciate ligament reconstruction. Arthroscopy 23(9):938–947PubMedCrossRef

25.

Zantop T, Weimann A, Wolle K, Musahl V, Langer M, Petersen W (2007) Initial and 6 weeks postoperative structural properties of soft tissue anterior cruciate ligament reconstruction with cross-pin or interference screw fixation: an in vivo study in sheep. Arthroscopy 23(1):14–20PubMedCrossRef

Title: Femoral bridge stability in double-bundle ACL reconstruction: impact of bridge width and different fixation techniques on the structural properties of the graft/femur complex
Authors: Ann-Kristin Lehmann
Nani Osada
Thore Zantop
Michael J. Raschke
Wolf Petersen
Publication date: 01-08-2009
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 8/2009
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-009-0869-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Femoral bridge stability in double-bundle ACL reconstruction: impact of bridge width and different fixation techniques on the structural properties of the graft/femur complex

Abstract

Background

Hypothesis

Study design

Methods

Results

Conclusion

Clinical relevance

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Hypothesis

Study design

Methods

Results

Conclusion

Clinical relevance

Please log in to get access to this content

Other articles of this Issue 8/2009

Fifth metatarsal avulsion fracture: a rational basis for postoperative treatment

Case report. An unusual cause of a patient presenting with an acutely locked knee: multiple benign fat pad cysts

Measurements of the quadriceps femoris function after meniscus refixation at the stable athlete’s knee

Knotless anatomic double-layer double-row rotator cuff repair: a novel technique re-establishing footprint and shape of full-thickness tears

Cirsoid aneurysm of the synovium of knee: a very rare pathology

Influence of an infrapatellar fat pad edema on patellofemoral biomechanics and knee kinematics: a possible relation to the anterior knee pain syndrome