Double-Bundle versus Single-Bundle Anterior Cruciate Ligament Reconstruction

Suomalainen, Piia; Moisala, Anna-Stina; Paakkala, Antti; Kannus, Pekka; Järvelä, Timo

doi:10.1177/0363546511405024

Cited by 74 publications

(28 citation statements)

References 44 publications

(29 reference statements)

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“…For instance, Tiamklang et al 34 found 6 studies presenting data on graft failure in their Cochrane meta-analysis, and there was no significant difference between double- and single-bundle ACL reconstruction. Moreover, Björnsson et al 5 found a trend toward fewer reruptures, and Suomalainen et al 32 , 33 found significantly fewer graft failures and subsequent revision ACL surgery after double-bundle ACL reconstruction than after single-bundle surgeries at 5-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Revision Surgery After Primary Anterior Cruciate Ligament Reconstruction

Yabroudi

Björnsson

Lynch

et al. 2016

Orthopaedic Journal of Sports Medicine

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Background:Revision anterior cruciate ligament (ACL) reconstruction surgery occurs in 5% to 15% of individuals undergoing ACL reconstruction. Identifying predictors for revision ACL surgery is of essence in the pursuit of creating adequate prevention programs and to identify individuals at risk for reinjury and revision.Purpose:To determine predictors of revision ACL surgery after failed primary ACL reconstruction.Study Design:Case-control study; Level of evidence, 3.Methods:A total of 251 participants (mean age ± SD, 26.1 ± 9.9 years) who had undergone primary ACL reconstruction 1 to 5 years earlier completed a comprehensive survey to determine predictors of revision ACL surgery at a mean 3.4 ± 1.3 years after the primary ACL reconstruction. Potential predictors that were assessed included subject characteristics (age at the time of surgery, time from injury to surgery, sex, body mass index, preinjury activity level, return to sport status), details of the initial injury (mechanism; concomitant injury to other ligaments, menisci, and cartilage), surgical details of the primary reconstruction (Lachman and pivot shift tests under anesthesia, graft type, femoral drilling technique, reconstruction technique), and postoperative course (length of rehabilitation, complications). Univariate and multivariate logistic regression analyses were performed to identify factors that predicted the need for revision ACL surgery.Results:Overall, 21 (8.4%) subjects underwent revision ACL surgery. Univariate analysis showed that younger age at the time of surgery (P = .003), participation in sports at a competitive level (P = .023), and double-bundle ACL reconstruction (P = .024) predicted increased risk of revision ACL surgery. Allograft reconstructions also demonstrated a trend toward greater risk of revision ACL surgery (P = .076). No other variables were significantly associated with revision ACL surgery. Multivariate analysis revealed that revision ACL surgery was only predicted by age at the time of surgery and graft type (autograft vs allograft).Conclusion:The overall revision ACL surgery rate after primary unilateral ACL reconstruction was 8.4%. Univariate predictors of revision ACL reconstruction included younger age at the time of surgery, competitive baseline activity level, and double-bundle ACL reconstruction. However, multivariable logistic regression analysis indicated that age and reconstruction performed with allograft were the only independent predictors of revision ACL reconstruction.

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Section: Discussionmentioning

confidence: 99%

Predictors of Revision Surgery After Primary Anterior Cruciate Ligament Reconstruction

Yabroudi

Björnsson

Lynch

et al. 2016

Orthopaedic Journal of Sports Medicine

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“…[78] Variability in healing was observed in these studies but longer follow-ups indicated a complete structural and morphological resemblance to the native ACL. [79–82] A significant delay in returning to sport following ACLR to nearly two years may allow complete healing of the ACL graft and possibly the prevention of early failure in ACLR knees.…”

Section: Biological Recovery Of the Kneementioning

confidence: 99%

Should Return to Sport be Delayed Until 2 Years After Anterior Cruciate Ligament Reconstruction? Biological and Functional Considerations

2016

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Anterior cruciate ligament (ACL) tears are common knee injuries sustained by athletes during sports participation. A devastating complication of returning to sport following ACL reconstruction (ACLR) is a second ACL injury. Strong evidence now indicates that younger, more active athletes are at particularly high risk for a second ACL injury and this risk is greatest within the first two years following ACLR. Nearly one-third of the younger cohort that resumes sports participation will sustain a second ACL injury within the first two years after ACLR. The evidence indicates that the risk of second injury may abate over this time period. The incidence rate of second injuries in the first year after ACLR is significantly greater than the rate in the second year. The lower relative risk in the second year may be related to athletes achieving baseline joint health and function well after the current expected timeline (6 to 12 months) to be released to unrestricted activity. This highlights a considerable debate in the return to sport decision process as to whether an athlete should wait until two years after ACLR to return to unrestricted, sports activity. In this review, we present evidence in the literature that athletes achieve baseline joint health and function approximately two years after ACLR. We postulate that delay in returning to sports for nearly two years will significantly reduce the incidence of second ACL injuries.

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“…Some studies have additionally found that their DB ACL reconstruction group had fewer notchplasties5 and better visual analog scale6 and knee scores than its SB counterpart 6,7,13,17,18. Suomalainen et al15,16 reported that their DB group had a lower reoperation rate due to graft failure and, in their 8-year study, Zaffagnini et al18 also reported a lower reoperation rate in their DB group, although in that study there were also knee problems other than graft ruptures. They concluded that the DB method resulted in less OA and a better range of motion than the SB ACL reconstruction method.…”

Section: Discussionmentioning

confidence: 99%

“…A graft was considered visible when intact graft fibers were seen, partially visible when only few graft fibers were seen (Figure 3), and invisible when no graft fibers were seen (Figure 4). 15…”

Section: Methodsmentioning

confidence: 99%

Effect of tunnel placements on clinical and magnetic resonance imaging findings 2 years after anterior cruciate ligament reconstruction using the double-bundle technique

Suomalainen¹,

Kiekara²,

Moisala³

et al. 2014

OAJSM

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PurposeThe purpose of the study reported here was to find out if the clinical and magnetic resonance imaging (MRI) findings of a reconstructed anterior cruciate ligament (ACL) have an association. Our hypothesis, which was based on the different functions of the ACL bundles, was that the visibility of the anteromedial graft would have an impact on anteroposterior stability, and the visibility of the posterolateral graft on rotational stability of the knee.MethodsThis study is a level II, prospective clinical and MRI study (NCT02000258). The study involved 75 patients. One experienced orthopedic surgeon performed all double-bundle ACL reconstructions. Two independent examiners made the clinical examinations at 2-year follow-up: clinical examination of the knee; KT-1000, International Knee Documentation Committee and Lysholm knee evaluation scores; and International Knee Documentation Committee functional score. The MRI evaluations were made by two musculoskeletal radiologists separately, and the means of these measurements were used.ResultsWe found that the location of the graft in the tibia had an impact on the MRI visibility of the graft at 2-year follow-up. There were significantly more partially or totally invisible grafts if the insertion of the graft was more anterior in the tibia. No association was found between the clinical results and the graft locations.ConclusionAnterior graft location in the tibia can cause graft invisibility in the MRI 2 years after ACL reconstruction, but this has no effect on the clinical recovery of the patient.

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Double-Bundle versus Single-Bundle Anterior Cruciate Ligament Reconstruction

Cited by 74 publications

References 44 publications

Predictors of Revision Surgery After Primary Anterior Cruciate Ligament Reconstruction

Predictors of Revision Surgery After Primary Anterior Cruciate Ligament Reconstruction

Should Return to Sport be Delayed Until 2 Years After Anterior Cruciate Ligament Reconstruction? Biological and Functional Considerations

Effect of tunnel placements on clinical and magnetic resonance imaging findings 2 years after anterior cruciate ligament reconstruction using the double-bundle technique

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