ACL double-bundle reconstruction with one tibial tunnel provides equal stability compared to two tibial tunnels

Drews, B.; Seitz, Alexander; Huth, Jochen; Bauer, Gerhard; Ignatius, Anita; Dürselen, Lutz

doi:10.1007/s00167-016-4199-6

Cited by 8 publications

(8 citation statements)

References 39 publications

(87 reference statements)

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“…In a biomechanical study, double-bundle ACL reconstruction with 1 tibial tunnel provided the same translation and rotational stability as a 2-tunnel reconstruction. 36 Tunnel communication does not affect clinical outcomes. 37 Conversely, Nukuto et al.…”

Section: Discussionmentioning

confidence: 99%

A Modified Anatomic Transtibial Double-Bundle Anterior Cruciate Ligament Reconstruction Provides Reliable Bone Tunnel Positioning

Sanada

Iwaso

Honda

et al. 2022

Arthroscopy, Sports Medicine, and Rehabilitation

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Section: Discussionmentioning

confidence: 99%

A Modified Anatomic Transtibial Double-Bundle Anterior Cruciate Ligament Reconstruction Provides Reliable Bone Tunnel Positioning

Sanada

Iwaso

Honda

et al. 2022

Arthroscopy, Sports Medicine, and Rehabilitation

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“…Compared with the 4-tunnel double-bundle ACL reconstruction technique, the technique of 3 tunnels is believed to gain the same level of stability, with easier technical steps and less complication. 23 The described ACL reconstruction technique is based on 3 tunnels, including 1 tibial tunnel and 2 femoral tunnels. This separation was believed to be better, as it has more advantages and a wide range of applications than the split of 1 femoral tunnel and 2 tibial tunnels.…”

Section: Discussionmentioning

confidence: 99%

A Simplified Double-Bundle Anterior Cruciate Ligament Reconstruction by the Three-Inside Technique With Two Suspension Buttons and One Interference Screw

Truong¹,

Kha

Huan

et al. 2022

Arthroscopy Techniques

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In comparison with the single-bundle technique, double-bundle anterior cruciate ligament (ACL) reconstruction has proven its superiority regarding biomechanical studies and clinical outcomes in both rotational knee stability and anterior translation function. However, the complexity and risk of complications remain a great concern for the orthopaedic surgeon performing double-bundle ACL reconstruction. We present a simplified double-bundle ACL reconstruction by the 3-inside technique with 2 suspension buttons and 1 interference screw. The semitendinosus tendon is tripled to be the anteromedial (AM) bundle, whereas the gracilis is doubled for the posterolateral (PL) bundle. We perform a 3-socket approach with an inside-out femoral tunnel for the AM bundle, an outside-in femoral tunnel for the PL bundle, and a retrograde tibial socket for the tibial bundle. Thus, this technique is, simply, a combination of 2 procedures: one single all-inside method (for the AM bundle) and one outside-in method (for the PL bundle), with which most arthroscopic surgeons are familiar. The AM and PL bundles are fixed at 30 and 45 , respectively, using 2 suspension buttons and 1 interference screw. Our simplified technique could reduce surgical costs and minimize complications while maintaining isometric position and appropriate graft size for each patient.

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“…On the tibial side, fixation was performed using an ACL TightRope (Arthrex Inc., Naples, Florida, USA) and, on the femoral side, the graft was fixed to a dynamometer (Fig. 1), as described previously [10].…”

Section: Methodsmentioning

confidence: 99%

“…The third step was testing of anterior tibial translation under 134 N anterior tibial load at 0°, 30°, 60° and 90° flexion. A static pivot shift was performed with a valgus load of 10 Nm and an internal tibial torque of 4 Nm in addition to the 134 N anterior tibial translation [10, 24, 45]. Anterior tibial translation was tested with three repetitions for each condition and flexion angle.…”

Section: Methodsmentioning

confidence: 99%

Function and strain of the anterolateral ligament part II: reconstruction

Drews

Kessler

Franz³

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose Anterolateral rotatory instability (ALRI) may result from isolated ruptures of the anterior cruciate ligament (ACL) or combined lesions with the anterolateral ligament (ALL). Biomechanical studies have demonstrated that the ALL contributes to the overall rotational stability of the knee. The purpose of this study was to investigate the biomechanical function of anatomic ALL reconstruction (ALL rec ) in the setting of a combined ACL and ALL injury and reconstruction. The hypothesis was that combined ACL reconstruction (ACL rec ) and ALL rec (ACL/ALL rec ) signiicantly reduces internal rotation and shows load sharing between both reconstructions compared with isolated ACL rec . Methods Eight fresh-frozen cadaveric knees were evaluated using a six degrees of freedom knee simulator. Continuous passive motion and external loads were tested. Kinematic diferences between ACL rec and combined ACL/ALL rec were compared. Additionally, ACL graft tension and ALL graft strain were measured continuously throughout the testing protocol. Results Combined anatomic ACL/ALL rec signiicantly improved the internal rotatory stability compared with isolated ACL rec at 30°-90° under an internal rotation moment. During a static pivot-shift test, additional ALL rec showed no signiicant reduction of ap-translation. ALL rec resulted in an increase in ACL graft tension during continuous passive motion and with additional internal rotation moment. Conclusion In the case of a combined ACL and ALL deiciency, concurrent ACL rec and ALL rec signiicantly improved the rotatory stability of the knee compared with solely reconstructing the ACL at lexion angles ≥ 30°. Nevertheless, additional ALL rec with ixation at 60° and with low tension could not restore extension-near rotatory stability. For that reason, ALL rec with ixation at 60° lexion cannot be recommended in clinical application.

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ACL double-bundle reconstruction with one tibial tunnel provides equal stability compared to two tibial tunnels

Cited by 8 publications

References 39 publications

A Modified Anatomic Transtibial Double-Bundle Anterior Cruciate Ligament Reconstruction Provides Reliable Bone Tunnel Positioning

A Modified Anatomic Transtibial Double-Bundle Anterior Cruciate Ligament Reconstruction Provides Reliable Bone Tunnel Positioning

A Simplified Double-Bundle Anterior Cruciate Ligament Reconstruction by the Three-Inside Technique With Two Suspension Buttons and One Interference Screw

Function and strain of the anterolateral ligament part II: reconstruction

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