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Document Title: Yasuda-AJARS-Dec04.shtml
Article Title: Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts
Authors: Kazunori Yasuda M.D., Ph.D., Eiji Kondo M.D., Hiroki Ichiyama M.D., Nobuto Kitamura M.D., Yoshie Tanabe R.P.T., Harukazu Tohyama M.D., Ph.D. and Akio Minami M.D., Ph.D.
Publication: Arthroscopy: The Journal of Arthroscopic & Related Surgery
Date: December 2004
Volume 20, Issue 10, December 2004, Pages 1015-1025
Keywords: Anterior cruciate ligament reconstruction, Dual-bundle procedure, Anatomic study, Hamstring tendon autograft, anteromedial bundle, posterolateral bundle.
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Comments: These authors found that double-bundle ACL reconstruction is clinically practical to perform. They found the results to be superior, and they note that the 2-bundle procedure displayed a better trend with respect to anterior stability in manual knee laxity tests. They also found that, in their KT-2000 arthrometer testing, fewer patients experienced graft failure (defined as greater than 5 mm of anterior drawer measured).
Abstract
Purpose: To develop and evaluate an anatomic reconstruction procedure of the posterolateral and anteromedial bundles of the anterior cruciate ligament (ACL).
Type of study: Anatomic study and case series. Methods: The femoral attachment of the anteromedial and posterolateral bundles of the ACL was anatomically analyzed with 5 cadaveric knees. Using another 3 cadaveric knees, anatomic reconstruction of the posterolateral and anteromedial bundles was performed with the transtibial technique, and tunnel positioning and graft function in a range of knee motion was observed. Based on this anatomic study, an anatomic reconstruction procedure of the anteromedial and posterolateral bundles was developed using hamstring tendon autografts. This procedure was carried out in 57 consecutive patients with an ACL-deficient knee. The patients were followed-up for a minimum of 24 months.
Results: We developed the arthroscopically assisted anatomic reconstruction procedure of the posterolateral and anteromedial bundles, involving a new method of creating the tibial and femoral tunnels for the posterolateral bundle. To visualize the femoral attachment of the posterolateral bundle, the medial infrapatellar portal was more useful than the lateral portal. In clinical results, the side-to-side difference of anterior laxity averaged 1.0 mm with a standard deviation of 0.9.
Conclusions: The anatomic reconstruction of the anteromedial and posterolateral bundles using hamstring tendon autografts is clinically practical in the treatment for the ACL-deficient knee.
Level of evidence: Level IV.
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