Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleAnatomic Reconstruction of the Anterior Cruciate Ligament Using Double-Bundle Hamstring Tendons: Surgical Techniques, Clinical Outcomes, and Complications
Section snippets
Methods
We retrospectively reviewed 123 consecutive patients with ACL-deficient knees who had undergone single- or double-bundle reconstruction between April 2002 and March 2004. Patients who underwent ACL reconstruction of both knees and those with an open physis were excluded from evaluation. Those with other ligamentous instability and those with articular cartilage lesions exceeding grade III were also excluded. The final study population consisted of 54 men and 69 women.
Double-bundle ACL
Manual Knee Laxity
In the double-bundle group the Lachman test was negative in 64 patients (90%), positive (+) in 5 (7%), and highly positive (++) in 2 (3%) (Table 2). The pivot-shift test was negative in 62 patients (87%), positive (+) in 7 (10%), and highly positive (++) in 2 (3%).
In the single-bundle group the Lachman test was negative in 45 patients (86%), positive (+) in 6 (12%), and highly positive (++) in 1 (2%). The pivot-shift test was negative in 42 patients (81%), positive (+) in 7 (14%), and highly
Discussion
Several authors have reported on the double-bundle procedure via hamstring tendons.1, 2, 3, 4, 5, 9, 10, 12, 13 Recently, Yasuda et al.9 reported on anatomic reconstruction of the AM and PL bundles of the ACL by use of hamstring tendon grafts. Good clinical results were reported with this method, and a new method of creating tibial and femoral tunnels for the PL bundle was introduced.
The ACL can be anatomically divided into AM and PL portions, each of which shows different tension patterns.4, 14
Conclusions
This study compared the results of double-bundle ACL reconstruction with those of single-bundle reconstruction and confirmed that there was no significant difference, with the exception of range of knee motion, between the 2 procedures. An extension deficit of greater than 5° was found in 19 cases (26%) in the double-bundle group and 6 cases (10%) in the single-bundle group (P < .05).
The findings of our study do not support the routine adoption of the double-bundle procedure until the
References (17)
- et al.
Double-stranded hamstring graft for anterior cruciate ligament reconstruction
Arthroscopy
(2004) - et al.
Single- versus bi-socket anterior cruciate ligament reconstruction using autogenous multiple-stranded hamstrings tendons with EndoButton for femoral fixation: A prospective study
Arthroscopy
(2001) - et al.
Comparisons of intraosseous graft healing between the doubled flexor tendon graft and the bone-patellar tendon-bone graft in anterior cruciate ligament reconstruction
Arthroscopy
(2001) - et al.
Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstrings tendon grafts
Arthroscopy
(2004) - et al.
Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: Comparisons among 3 different procedures
Arthroscopy
(2006) - et al.
A retrospective study of the midterm outcome of two-bundle anterior cruciate ligament reconstruction using quadrupled semitendinosus tendon in comparison with one-bundle reconstruction
Arthroscopy
(2006) - et al.
Single- versus two-femoral socket anterior cruciate ligament reconstruction technique: Biomechanical analysis using a robotic simulator
Arthroscopy
(2001) Semitendinosus anatomic reconstruction for cruciate ligament insufficiency
Clin Orthop Relat Res
(1983)
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2020, Journal of Orthopaedic ScienceACL reconstruction with lateral extra-articular tenodesis using a continuous graft: 10-year outcomes of 50 cases
2020, Orthopaedics and Traumatology: Surgery and ResearchCitation Excerpt :This can be explained by the fact that the anterolateral ligament (ALL) may be torn in as many as 93% of those who suffer an ACL rupture [3]. One of the solutions proposed to this problem is double-bundle ACL reconstruction; while this procedure is effective at reducing the residual pivot sift [4], the drawback is its adverse effects (cyclops syndrome, tunnel fracture) [5,6]. Another solution is adding lateral extra-articular tenodesis (LET) to the intra-articular ACL reconstruction.
ACL reconstruction with lateral extra-articular tenodesis using a continuous graft: 10-year outcomes of 50 cases
2020, Revue de Chirurgie Orthopedique et TraumatologiqueSecond-look arthroscopy after anatomic anterior cruciate ligament reconstruction: Bone-patellar tendon-bone versus hamstring tendon graft
2019, Journal of Orthopaedic Science
The authors report no conflict of interest.