Does the posterolateral bundle influence rotational movement more than the anteromedial bundle in anterior cruciate ligament reconstruction?

Abstract

The biomechanical function of the anteromedial (AM) and posterolateral (PL) bundles of the anterior cruciate ligament (ACL) remains controversial. Some studies report that the AM bundle stabilises the knee joint in anteroposterior (AP) translation and rotational movement (both internal and external) to the same extent as the PL bundle. Others conclude that the PL bundle is more important than the AM in controlling rotational movement. The objective of this randomised cohort study involving 60 patients (39 men and 21 women) with a mean age of 32.9 years (18 to 53) was to evaluate the function of the AM and the PL bundles of the ACL in both AP and rotational movements of the knee joint after single-bundle and double-bundle ACL reconstruction using a computer navigation system. In the double-bundle group the patients were also randomised to have the AM or the PL bundle tensioned first, with knee laxity measured after each stage of reconstruction. All patients had isolated complete ACL tears, and the presence of a meniscal injury was the only supplementary pathology permitted for inclusion in the trial. The KT-1000 arthrometer was used to apply a constant load to evaluate the AP translation and the rolimeter was used to apply a constant rotational force. For the single-bundle group deviation was measured before and after ACL reconstruction. In the double-bundle group deviation was measured for the ACL-deficient, AM- or PL-reconstructed first conditions and for the total reconstruction. We found that the AM bundle in the double-bundle group controlled rotation as much as the single-bundle technique, and to a greater extent than the PL bundle in the double-bundle technique. The double-bundle technique increases AP translation and rotational stability in internal rotation more than the single-bundle technique.

A new technique in double-bundle anterior cruciate ligament reconstruction with implant-free tibial fixation

“…In addition, no patients presented "abnormal" or "severely abnormal" knee laxity or graft failures at the 2-year follow-up. These data corroborate previous studies that showed low graft failure incidence in patients submitted to double-bundle reconstruction [13,25]. Moreover, the present outcomes referring to normal function, satisfactory stability, and an absence of post-operative complications allow the authors of this study to affirm that double-bundle reconstruction without tibial implants is a safe technique and provides similar outcomes than other technique with four implants.…”

“…Several biomechanical [28][29][30] and clinical studies [11,13,19] have investigated the relevance of additional posterolateral (PL) bundle on knee transversal plane stability. Recent systematic review reported superior clinical results in relation to the anterior and rotational stability in patients who received an anatomic double-bundle technique when compared to a single-bundle technique [27].…”

Clinical outcomes of second-look arthroscopic evaluation after anterior cruciate ligament augmentation

“…1,2 The double-bundle method aims to reconstruct both the anteromedial (AM) and posterolateral (PL) bundles of the native ACL at their sites of insertion. However, recent studies have shown that central anatomical singlebundle ACL reconstruction can also restore normal knee function.…”

Evaluation of the intraoperative kinematics during double-bundle anterior cruciate ligament reconstruction using a navigation system

“…Moreover, Komzák et al. reported that reconstruction of the AM bundle had a greater effect on reducing internal rotation than reconstruction the PL bundle 30 . The addition of anterolateral ligament reconstruction may be desirable in patients who have massive rotational knee instability.…”