Double-Bundle Versus Single-Bundle Anterior Cruciate Ligament Reconstruction in Patients With Significant Passive Anterior Tibial Subluxation

Abstract

Background: Passive anterior tibial subluxation (PATS) is often observed in patients with anterior cruciate ligament tears. Postoperative outcomes of double-bundle (DB) and single-bundle (SB) anterior cruciate ligament reconstruction (ACLR) with significant PATS (>6 mm) are unclear. Hypothesis: DB-ACLR could achieve better stability and clinical outcomes than SB-ACLR in patients with PATS >6 mm. Study Design: Cohort study; Level of evidence, 3. Methods: Retrospective analysis was peformed on 626 consecutive patients who underwent primary anatomic ACLR between October 2016 and November 2017. Anterior subluxation of the lateral and medial compartments in extension relative to the femoral condyles was measured on preoperative magnetic resonance imaging scans. Among patients who demonstrated significant PATS (>6 mm) in the lateral compartment, 54 who underwent DB-ACLR (study group) were matched to 54 who underwent SB-ACLR (control group). PATS, stability (pivot-shift test and KT-2000 arthrometer), the Lysholm score, and the International Knee Documentation Committee (IKDC) grade were investigated preoperatively and at 3- to 4-year follow-up. Results: The preoperative mean PATS values in the lateral and medial compartments were not significantly different between groups (control vs study: lateral compartment, 8.1 ± 1.8 vs 8.5 ± 2.1 mm; medial compartment, 5.2 ± 1.9 vs 5.4 ± 1.9 mm; P > .05). Postoperatively, mean PATS values in the lateral and medial compartments of the study group were significantly improved as compared with the control group (control vs study: lateral compartment, 5.9 ± 2.8 vs 3.2 ± 4.1 mm; medial compartment, 3.7 ± 2.9 vs 1.4 ± 2.3 mm; P < .05). Significantly superior results were found for knee stability in the study group regarding the Lachman test (grade 0/1/2/3, study vs control: 29/22/3/0 vs 16/28/10/0; P = .031), pivot-shift test (grade 0/1/2/3, study vs control: 44/9/1/0 vs 30/19/5/0; P = .023), and KT-2000 arthrometer (study vs control: 2.5 ± 1.5 vs 3.9 ± 1.4 mm; P < .001). Clinical scores showed significantly better results in the study group in terms of IKDC score (study vs control: 87.9 ± 8.7 vs 81.2 ± 15.0; P = .01), Tegner activity score (study vs control: 6.0 ± 1.4 vs 4.9 ± 1.5; P < .001), and Lysholm score (study vs control: 91.7 ± 7.0 vs 86.3 ± 11.4; P = .004). Conclusion: DB-ACLR achieved better knee stability and clinical outcomes when compared with SB-ACLR in patients with PATS >6 mm at 3- to 4-year follow-up.

Meniscal resection increases the risk of residual knee laxity even in patients undergoing anatomic double-bundle anterior cruciate ligament reconstruction with eight strands of hamstring autografts

“…Notably, most patients in the current study were non‐professional athletes with chronic ACL tears, and it is difficult to compare their outcomes with those in the aforementioned studies due to different demographic characteristics, preoperative instability, surgical techniques, and sports levels. Lin et al [20] compared DB‐ACLR with SB‐ACLR in patients with excessive anterior tibial subluxation and concluded that DB‐ACLR resulted in better knee stability and patient‐reported outcomes; however, the equivalent graft diameter of DB‐ACLR (6–8 strands of hamstrings) was larger than that of SB‐ACLR (HT4), which may be a major confounder. Further studies are warranted to compare the two techniques in the premise of comparable graft sizes.…”

“…For hamstring autografts, an increase in the graft diameter between 7 and 10 mm usually results in a lower rate of ACLR failure and revision surgery [17,18]. Furthermore, double-bundle (DB) ACLR may be superior to single-bundle (SB) ACLR in restoring anteroposterior and rotatory stability and reducing the clinical failure rate [20][21][22]. Some researchers have applied a strategy of preparing eight strands of hamstring (HT8) autografts, comprising the 4-stranded ST and 4-stranded GT, to increase the total graft size of DB-ACLR and improve knee stability [23,24].…”

Variations in postoperative electrolyte concentrations and influential factors in hip arthroscopy

“…No prophylactic antibiotics were administered. Meanwhile, arthroscopic single-bundle ACL reconstruction was performed by the same surgeon as previously described [ 18 ]. In brief, tourniquet was routinely used during the surgery.…”

Comparison of the Clinical Outcomes of Revision and Primary ACL Reconstruction: A Matched-Pair Analysis With 3-5 Years of Follow-up

“…A standard institutional MRI examination with a 1.5-T superconducting magnet (Optima MR360; GE) was performed. Electronic measurements were performed by observers to determine anterior subluxation in the lateral tibial compartment relative to a posterior femoral condylar reference line on sagittal MRI scans, as first described and validated by Iwaki et al 18 and later utilized by Tanaka et al 44 This technique was also used by Song et al 42 and Lin et al 25 The amount of PATS was measured on the MRI scans within 2 months preoperatively.…”