An In Vitro Biomechanical Comparison of Anterior Cruciate Ligament Reconstruction: Single Bundle Versus Anatomical Double Bundle Techniques

Abstract

INTRODUCTIONAnterior cruciate ligament ruptures are frequent, especially in sports. Surgical reconstruction with autologous grafts is widely employed in the international literature. Controversies remain with respect to technique variations as continuous research for improvement takes place. One of these variations is the anatomical double bundle technique, which is performed instead of the conventional single bundle technique. More recently, there has been a tendency towards positioning the two bundles through double bone tunnels in the femur and tibia (anatomical reconstruction).OBJECTIVESTo compare, through biomechanical tests, the practice of anatomical double bundle anterior cruciate ligament reconstruction with a patellar graft to conventional single bundle reconstruction with the same amount of patellar graft in a paired experimental cadaver study.METHODSNine pairs of male cadaver knees ranging in age from 44 to 63 years were randomized into two groups: group A (single bundle) and group B (anatomical reconstruction). Each knee was biomechanically tested under three conditions: intact anterior cruciate ligament, reconstructed anterior cruciate ligament, and injured anterior cruciate ligament. Maximum anterior dislocation, rigidity, and passive internal tibia rotation were recorded with knees submitted to a 100 N horizontal anterior dislocation force applied to the tibia with the knees at 30, 60 and 90 degrees of flexion.RESULTSThere were no differences between the two techniques for any of the measurements by ANOVA tests.CONCLUSIONThe technique of anatomical double bundle reconstruction of the anterior cruciate ligament with bone-patellar tendon-bone graft has a similar biomechanical behavior with regard to anterior tibial dislocation, rigidity, and passive internal tibial rotation.

Systematic review on cadaveric studies of anatomic anterior cruciate ligament reconstruction

“…Of those papers, 18 were selected by both observers and the remaining 4 were discussed an excluded after consensus. Therefore, 18 papers were selected for final inclusion in the systematic review [ 1 , 2 , 6 – 8 , 10 , 12 , 17 , 18 , 20 – 22 , 24 , 30 , 31 , 33 , 36 , 37 ]. The other 77 studies were mostly excluded because they did not claim that their reconstructive technique was anatomic.…”

In Vitro and Intraoperative Laxities After Single-Bundle and Double-Bundle Anterior Cruciate Ligament Reconstructions

“…Ten studies from these 21 studies were excluded, four22,23,39,41 because no variance and/or means were reported, one9 study that used prosthetic ligament for reconstruction, one37 study that used sheep knee specimens, one34 study that used a rectangular femoral tunnel for single bundle ACL reconstruction, two38,40 studies due to duplication of data and one35 review article. One of the included studies reported only rotational laxity 36.…”

Reconstruction Technique Affects Femoral Tunnel Placement in ACL Reconstruction

“…Instead, the ACL appeared to be a continuous structure consisting of many different fiber bundles of different lengths and orientations. Although we did not separate the ACL stump into two or three bundles, the data generated from this study are important, as anatomic femoral tunnel placement has been a concern in single-and double-bundle ACL reconstructions [16,55], and whether a single-or double-bundle reconstruction should be performed remains controversial [1,10,26,41,43,47,49,52] and is outside the scope of this study. Finally, we do not know how much difference in placement will substantially alter the risk of either graft failure or long-term degeneration; both would require clinical confirmation.…”