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Document Title: Colombet-KSSTA-Jul06.shtml
Article Title: Two-bundle, four-tunnel anterior cruciate ligament reconstruction
Authors: Philippe Colombet, James Robinson, Stephane Jambou, Michael Allard, Vincent Bousquet, Christophe de Lavigne.
Publication: Knee Surgery, Sports Traumatology, Arthroscopy
Date: July 2006
Volume 14, pages 629-636
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 ACL reconstruction via double-bundle grafting (with four tunnels, i.e. two in each bone) brings promising results. They cautiously note that their results are at least as good as other techniques, and note a trend towards better control of forwards tibial sliding (anterior drawer). Please note that, currently, only the hamstring-type graft is amenable to double-bundle grafting methods.
Abstract
We reviewed 33 patients who underwent anterior cruciate ligament (ACL) reconstruction using a two-bundle, four-tunnel technique. The posterolateral bundle (PLB) and anteromedial bundle (AMB) were individually reconstructed with gracilis and semitendinosus tendon auto-grafts, respectively, using separate tibial and femoral tunnels. At final follow-up (24 months post surgery, range 18-31), the International Knee Documentation Committee's (IKDC) objective final evaluation scores were 69 A, 19 B, and 12% C. The mean global subjective IKDC score was 86 ± 12 points. Ninety-four percent of the patients had returned to sport after an average of 9 months following surgery, adn 75% returned to their preinjury sporting level. One patient had suffered a graft rupture as a result of a further sports injury. Eighty-four percent of the patients had a negative pivot shift (IKDC A), 9% a glide (IKDC B), and 6% a "clunk" (IKDC C). The mean postoperative side-to-side laxity, measured with KT1000 arthrometry at manual maximum, was 0.9 mm (SD 1.9). Eighty-one percent of the patients had less than 3 mm difference, with only one patient having greater than 5 mm. Our early experience with this new technique appears to demonstrate satisfactory results that are at least equivalent to other techniques and show an apparent trend towards improved control of anterior laxity.
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