Arthroscopic evaluation of ACL grafts reconstructed with the anatomical two-bundle technique using hamstring tendon autograft

Abstract

This article describes second-look arthroscopic evaluation of the transplanted grafts after anatomical two-bundle ACL reconstruction, which had been performed between December 2000 and March 2004. Using two double-looped semitendinosus tendon grafts via separate femoral and tibial tunnels in the anatomical ACL footprints, 65 patients (mean age of 24 years) underwent anatomical two-bundle ACL reconstruction. The evaluation was performed for those who had undergone the procedure 5-29 months (mean 16.5) previously, with emphasis on graft tension and the presence of graft damage by meticulous probing. None of the anteromedial (AM) grafts showed rupture, while 11% of the posterolateral (PL) grafts showed substantial damage around the femoral tunnel aperture. Both the AM and PL grafts were evaluated as lax without apparent graft rupture in 9% of the knees. These results suggest that the currently performed anatomical two-bundle ACL reconstruction and postoperative regimen still remain to be improved to achieve better postoperative graft morphology.

Effects of single-bundle and double-bundle ACL reconstruction on tibiofemoral compressive stresses and joint kinematics during simulated squatting

“…Some studies suggest tensioning the AM bundle between 45° and 90° of flexion and the PL near full extension, with the theory being to tension the bundles at the degree of knee flexion at which they function 3, 20, 23, 25, 47–48 . Other studies suggest tensioning both bundles between 15° and 20°, thereby avoiding excessive stress in either bundle, which may produce stress shielding in the other 3,14, 21–22, 49–52 . The protocol for bundle tensioning may have a significant effect on the bundle loading patterns in DB-ACLR, which in turn could influence TF compressive stresses 38 .…”

In Vivo Analysis of Dynamic Graft Bending Angle in Anterior Cruciate Ligament–Reconstructed Knees During Downward Running and Level Walking: Comparison of Flexible and Rigid Drills for Transportal Technique

“…Partial damage or poor synovial coverage of the reconstructed graft have been reported during second-look arthroscopy, and may be related to increased laxity 21-24 . A recent analysis based on the Danish ACL registry reported an increased revision rate with anatomic ACL reconstruction, compared with the conventional trans-tibial technique 25 .…”

Second-look arthroscopic findings and clinical results after polyethylene terephthalate augmented anterior cruciate ligament reconstruction

“…As follow-up arthroscopic evaluations are only indicated for clinical diagnosis and serial second-look arthroscopic studies are not ethically defensible, there is an obvious lack of information based on arthroscopic surveys and re-examinations of patients with good clinical outcome. In the literature there are only a couple of surveys focusing on arthroscopic morphological graft condition and the correlative clinical status particularly in line with polyethylene terephthalate augmentation [16][17][18]. In our study second-look arthroscopic evaluation was carried out when removal of the synthetic polyethylene terephthalate augmentation, used as supplemental PBTB graft protection, became necessary.…”