Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleOutcomes After Double-Bundle Anterior Cruciate Ligament Reconstruction
Section snippets
Patients and Inclusion/Exclusion Criteria
After obtaining institutional review board approval for this retrospective trial, we reviewed the medical records of consecutive ACL reconstructions by one surgeon (J.H.A.) from January 2006 to September 2012. We started DB reconstruction since January 2005. Considering the learning period of 1 year and a minimum follow-up duration of 3 years, patients from January 2006 to September 2012 were enrolled. Patients were eligible for enrollment if they were at least 3 years out from DB ACL
Results
Among the 340 patients, 50 were ruled out after application of the exclusion criteria (Fig 5). Therefore, 290 DB ACL reconstructions with postoperative 3D-CT and a minimum 3-year follow-up were finally enrolled. According to the overall IKDC objective rating at the last follow-up, 290 enrolled DB ACL reconstructions were sorted into the superior outcomes (IKDC grade A or B, n = 240) and inferior outcomes groups (IKDC grade C or D, n = 50).
Demographic and clinical characteristics of each group
Discussion
The most important finding of the present study was that the specific risk factors that predicted the inferior postoperative outcomes were anterior or distal femoral AM tunnel position in postoperative 3D CT, partial meniscectomy of medial or lateral meniscus injury, and delayed time from injury to DB ACL reconstruction, especially more than 11.5 weeks from injury.
Various previous studies have addressed clinical and functional results according to the tunnel position after DB ACL reconstruction.
Conclusion
Anterior or distal AM femoral tunnel position, partial meniscectomy of medial or lateral meniscus, and prolonged surgical delay of more than 11.5 weeks from injury were significant risk factors for the inferior clinical outcomes after DB ACL reconstruction.
References (25)
- et al.
Mid- to long-term results of single-bundle versus double-bundle anterior cruciate ligament reconstruction: Randomized controlled trial
Arthroscopy
(2015) - et al.
Hamstring autograft size can be predicted and is a potential risk factor for anterior cruciate ligament reconstruction failure
Arthroscopy
(2014) - et al.
Graft size and patient age are predictors of early revision after anterior cruciate ligament reconstruction with hamstring autograft
Arthroscopy
(2012) - et al.
Outcome and risk factors after anterior cruciate ligament reconstruction: A follow-up study of 948 patients
Arthroscopy
(2005) - et al.
Analysis of the risk factors regarding anterior cruciate ligament reconstruction using multiple-looped semitendinosus tendon
Knee
(2005) - et al.
Anatomic placement of the femoral tunnels in double-bundle anterior cruciate ligament reconstruction correlates with improved graft maturation and clinical outcomes
Arthroscopy
(2015) - et al.
Impact of tibial and femoral tunnel position on clinical results after anterior cruciate ligament reconstruction
Arthroscopy
(2011) Evidence-based ACL reconstruction
Arch Bone Jt Surg
(2015)Twenty-year experience of a double-bundle anterior cruciate ligament reconstruction
Clin Orthop Surg
(2015)- et al.
Meniscal integrity predicts laxity of anterior cruciate ligament reconstruction
Knee Surg Sports Traumatol Arthrosc
(2015)
Posterior tibial slope influences static anterior tibial translation in anterior cruciate ligament reconstruction: A minimum 2-year follow-up study
Am J Sports Med
Posterior tibial slope and further anterior cruciate ligament injuries in the anterior cruciate ligament-reconstructed patient
Am J Sports Med
Cited by (11)
Anatomical Triple Bundle Anterior Cruciate Ligament Reconstructions With Hamstring Tendon Autografts: Tunnel Locations and 2-Year Clinical Outcomes
2021, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :These results were quite close to the previous report in the anatomic rectangular tunnel ACL reconstruction with a BTB graft using the same strategy.24 Tunnel location is one of the important factors influencing postoperative outcomes in ACL reconstruction.1-4 Thus we always remove the ACL remnant with the bony surface left intact to arthroscopically identify the bony landmarks at the time of tunnel creation.
Intraoperative fluoroscopy shows better agreement and interchangeability in tibial tunnel location during single bundle anterior cruciate ligament reconstruction with postoperative three-dimensional computed tomography compared with an intraoperative image-free navigation system
2020, KneeCitation Excerpt :This study did not suggest whether either fluoroscopy or navigation is superior to create the tibial tunnel. Tunnel location is one of the most crucial factors affecting the postoperative outcomes [20–23]; therefore, it is important to assess the tunnel locations accurately and reproducibly, and it can be most precisely evaluated postoperatively using 3DCT. Previous studies have reported that feedback from postoperative 3DCT is effective in the learning process to improve accuracy and precision of tunnel placement to obtain anatomical reconstruction as well as reduce operative time [24,25].
Is intraoperative fluoroscopy necessary in anterior cruciate ligament double-bundle reconstruction? A prospective randomized controlled trial
2019, Orthopaedics and Traumatology: Surgery and ResearchCitation Excerpt :Ahn et al. [18] have suggested that high or shallow position of the femoral AM bundle tunnel, partial meniscectomy of the medial or lateral meniscus, and prolonged surgical delay of more than 11.5 weeks from injury are significant risk factors for inferior clinical outcomes after ACL DB reconstruction. In their study, partial meniscectomy of medial meniscus was the strongest predictor for inferior outcomes [18]. In our study, there was no statistically significant difference in meniscal injury or surgical delay from injury between the two groups.
Editorial Commentary: Prognosticators for Outcomes After Anterior Cruciate Ligament Reconstruction…Time to Beat a Different Dead Horse?
2018, Arthroscopy - Journal of Arthroscopic and Related Surgery
See commentary on page 231
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.