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Document Title: Adachi-JBJSB-May04.shtml
Article Title: Reconstruction of the anterior cruciate ligament: Single versus double-bundle multistranded hamstring tendons
Authors: N. Adachi, M. Ochi, Y. Uchio, J. Iwasa, M. Kuriwaka,
Y. Ito
Publication: Journal of Bone and Joint Surgery, British Edition
Date: May 2004
Volume 86-B, pages 515-20
Keywords: ACL reconstruction, single versus double-bundle grafting.
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)
Comments: These authors found that, despite that theoretical advantages of double-bundle ACL grafting, no clinical (i.e. measured functionally in real, live people) advantages could be found. However, it should be kept in mind that the biomechanical nuances of the human knee are quite difficult to measure in practice. No surgeon can detect, using manual-manipulation testing (e.g. Lachmann drawer test or the mechanical equivalent, the KT-1000/2000 arthrometer), whether the actual knee motion is that of a single-bundle ACL graft or a double-bundle one. But over the lifetime of a person, the biomechanical differences between a knee with a natural ACL and a reconstructed one show themselves in terms of accelerated wear to articular cartilage and menisci in the rebuilt knee. Such cartilage wear means osteoarthritis. (Note: ACL-injury-history knees also harbour a certain amount of irreversible damage from the initial injury event. This includes the aftermath of bone bruising and meniscal tearing.) Keep in mind that double-bundle grafting brings technical problems: it makes far greater demands on the surgeon's skill...and regular single-bundle ACL grafting is already very difficult for a surgeon to master. Evidence of this can be found in the fact that misplaced bone tunnels (i.e. surgeon error) are still the major cause of ACL-grafting failure. A correctly installed single-bundle ACL graft is much better than a poorly done double-bundle graft!
Abstract
A total of 108 patients with unilateral instability of the knee, associated with rupture of the anterior cruciate ligament, was prospectively randomised for arthroscopic single- or double-bundle reconstruction of the ligament using hamstring tendons. The same post-operative rehabilitation protocol was used for all. The patients were followed up for a mean of 32 months (24 to 36). We measured the anterior laxity and joint position sense at different angles of flexion of the knee to determine whether both bundles in the double-bundle reconstruction contributed to the stability of the joint and proprioception. No significant difference was found between the two groups with regard to anterior laxity measured by the KT-2000 arthrometer with the knee at 20° or 70° flexion nor with regard to proprioception. A notchplasty was required less often in the double- compared with the single-bundle reconstruction.
We did not find any advantage in a double-bundle as opposed to a single-bundle reconstruction in terms of stability or proprioception.
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