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Document Title: Yasuda-AJARS-Mar06.shtml
Article Title: Clinical Evaluation of Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Procedure Using Hamstring Tendon Grafts: Comparisons Among 3 Different Procedures
Authors: Kazunori Yasuda M.D., Ph.D., Eiji Kondo M.D., Hiroki Ichiyama M.D., Yoshie Tanabe RPT, M.S. and Harukazu Tohyama M.D., Ph.D.
Publication: Arthroscopy: The Journal of Arthroscopic & Related Surgery
Date: March 2006.
Volume 22, Number 3, pages 240-251
Keywords: Clinical study, double-bundle versus single-bundle ACL grafting, hamstring tendon autografting, soft-tissue graft fixation, Anterior cruciate ligament, Anatomic double-bundle reconstruction; Hamstring tendon autograft; anteromedial bundle of ACL, posterolateral bundle of ACL
(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 double-bundle ACL reconstruction brings substantially better results than single-bundle grafting. Keep in mind that there are two general graft-placement schools of thought: isometric (i.e. the bone tunnels are drilled in locations so that the graft will remain the same length throughout the knee range of motion) and anatomic (i.e. the bone tunnels are centered on the location of the original ACL stumps.
Abstract
Purpose: To compare the clinical outcome of anatomic double-bundle anterior cruciate ligament (ACL) reconstruction with that of nonanatomic single- and double-bundle reconstructions.
Type of Study: Prospective comparative cohort study.
Methods: Seventy-two patients with unilateral ACL-deficient knees were randomly divided into 3 groups. Concerning all background factors, there were no statistical differences among the 3 groups. In group S (n = 24), single-bundle ACL reconstruction was performed. In group N-AD (n = 24), nonanatomic double-bundle reconstruction was carried out. In group AD (n = 24), anatomic double-bundle reconstruction was performed. One surgeon performed all operations using hamstring tendon autografts. Each patient underwent clinical examinations, before surgery and at 2 years.
Results: No intraoperative and postoperative complications were experienced in each group. There were no significant differences concerning the time for operation among the 3 groups. The statistical analysis showed a significant difference in the postoperative side-to-side anterior laxity among the 3 groups (P = .006). The laxity was significantly less (P = .002) in group AD (1.1 mm) than in group S (2.8 mm), while there was no significant difference (P = .072) between groups AD and N-AD. Concerning the pivot-shift test, group AD was significantly superior to group S (P = .025). There were no significant differences in the range of knee motion, the muscle torque, and the International Knee Documentation Committee evaluation.
Conclusions: On the basis of the KT-2000 measurement, the side-to-side anterior laxity of our anatomic double-bundle ACL reconstruction was significantly better than that of the single-bundle reconstruction with the hamstring tendon graft, although there were no significant differences in the other clinical measures among any of the 3 procedures.
Level of Evidence: Level II.
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