Anatomic Single- and Double-Bundle Anterior Cruciate Ligament Reconstruction, Part 2

Over recent years, double-bundle reconstruction has gained popularity after studies showed significant advantages of adding a second bundle with regard to outcomes and biomechanics; in particular, it resulted in less rotational instability than after reconstruction with a traditional single-bundle technique. As the focus shifted further towards the restoration of the native anatomy, both single-bundle and double-bundle ACL reconstruction were performed in an anatomical fashion and yielded similar results. To date, no consensus has developed as to whether double-bundle reconstruction is better than single-bundle reconstruction or vice versa. However, after surgeons started to individualise their surgical approach to the patient, it has been found that both the anatomical single-and double-bundle techniques have their own set of indications and contraindications. Reconstruction of the ligament should focus on restoration of the native functional and anatomical properties and should take the size, shape and orientation of the ACL into account. When indications and contraindications for the technique used are based on native anatomical characteristics, either a single-bundle or a doublebundle procedure can be performed according to the same double-bundle concept.

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“…Specifically, pivot-shift test results may differ significantly from what is found during office examination [27].…”

Section: Surgerymentioning

confidence: 88%

Indications and contraindications for double-bundle ACL reconstruction

Muller

Hofbauer

Wongcharoenwatana

et al. 2012

International Orthopaedics (SICOT)

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“…Although the proposition of a double bundle method has been around since the 1930's, the technique has become more popular in recent years with advancements in surgical methodology and the suggestion that it more closely resembles the native ACL; hence improving patient outcomes (Chalmers et al, 2013;Gadikota et al, 2010;Karlsson et al, 2011;Park et al, 2010;Schindler, 2012;van Eck et al, 2010).…”

Section: Graft Selectionmentioning

confidence: 99%

“…For this reason, the single bundle method is currently the most commonly performed procedure and supported as an acceptable method within the literature (Karlsson et al, 2011;Lewis et al, 2008).…”

Section: Graft Selectionmentioning

confidence: 99%

“…A poorly placed tunnel will result in greater laxity, graft impingement, loss of ROM, undue graft tension through ROM, greater risk of graft failure and poorer clinical outcomes for the patient (Beynnon et al, 2005;Karlsson et al, 2011). Correct placement of the tunnel is complex, with consideration of three-dimensional positioning across the tibial and femoral tunnels fundamental to success.…”

Section: Tunnel Placementmentioning

confidence: 99%

“…The aim of an ideal tunnel position is to avoid posterior cruciate ligament (PCL) impingement and ensure normal flexion, avoid roof impingement to restore normal extension and match the native ACL tension pattern to restore biomechanics (Howell & Hull, 2009). Although it is not clear exactly what the perfect tunnel position is, aiming for an anatomically placed tunnel to anchor the graft in a position that best replicates the native ACL is considered the gold standard (Cross et al, 2012;Karlsson et al, 2011;van Eck et al, 2010).…”

Section: Tunnel Placementmentioning

confidence: 99%

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Graft tensioning in anterior cruciate ligament reconstruction

Kirwan¹

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BackgroundAnterior cruciate ligament reconstruction (ACLR) is an effective procedure for restoring stability and function. Being a technically demanding procedure, patient outcomes are highly dependent on numerous surgical factors, which are critical for success. The application of tension to the graft prior to tibial fixation is one such factor and is considered essential for the restoration of joint stability, normal knee biomechanics, graft revascularisation and patient function. In applying tension, a key factor is the amount of force applied to the graft. However, the method of applying the tension, position of the knee during tensioning, properties of the graft material, tunnel placement and graft fixation device can all influence the effect that graft tension has on outcomes. Despite the reported importance of graft tension there has been limited empirical evidence defining the best tensioning practice for restoring patient outcome post ACLR. AimsThe goal of this program of research was to explore the effect that different aspects of graft tensioning has on patient function post ACLR. To address the aims of the thesis, three studies were conducted. The first study was a systematic review aimed at examining if a particular amount of tension results in better functional outcomes post ACLR. The second study aimed to compare the effect of two methods of applying graft tension on patient function post ACLR. The study used a prospective randomised controlled trial to compare manual tensioning with the use of a tensioning device. The third study aimed to define current graft tensioning practices and explore the factors that influence surgical decision making. A national survey of Australian orthopaedic surgeons was conducted to achieve the aims of the study. ResultsThe systematic review (study one) revealed that a medium graft tension of 79N to 90N produced the least side-to-side difference (STSD) in anterior posterior (AP) tibial translation as measured by a KT-1000 when compared to tensions <79 or >90N. However, the heterogeneous use of functional outcomes inhibited the ability to draw conclusions on other patient specific functional outcomes.Furthermore, the review highlighted the lack of high quality studies, which also failed to discuss other aspects of graft tension such as the method of applying tension.iii Building on the findings of study one, the second study undertook a RCT to compare the functional outcomes of applying 80N of force with a tensioning device (TD) (n=10) to a manual tensioning method (MT) (n=13) using an estimated force described as a sustained maximum one handed pull.Patients were assessed at pre-surgery and two weeks, three months, six months and 12 months post Based on the findings of study one, tensioning between 79N and 90N appeared to improve the restoration of joint stability, when compared to higher and lower tensions. However, no effect on patient function within 24 months post surgery was apparent. Furthermore, study two observed that tension did not appear to have an...

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Knee Joint

Benninger¹

2016

Bergman's Comprehensive Encyclopedia of Human Anatomic Variation

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Anatomic Single- and Double-Bundle Anterior Cruciate Ligament Reconstruction, Part 2

Cited by 130 publications

References 82 publications

Indications and contraindications for double-bundle ACL reconstruction

Indications and contraindications for double-bundle ACL reconstruction

Graft tensioning in anterior cruciate ligament reconstruction

Knee Joint

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