Reconstruction of anterior cruciate ligament using the doubled tendon graft technique: an experimental study in rabbits

Kalliakmanis

International Orthopaedics (SICO

et al. 2007

An experimental study was conducted in order to evaluate biomechanical methods of single-bundle reconstruction in ACL and compare it with a new double-bundle double-tibial tunnel technique. Twenty-four porcine cadaver knees, divided into 4 groups of 6 knees each and 48 proper extensors of the fourth toe tendons, were used for the fixation techniques. In groups A and B, a double-bundle technique with a single femoral and tibial tunnel was used, fixed to a femoral and tibial post with screws and with buttons, respectively. In groups C and D, a double-bundle technique (technique Delta) with two separate tibial tunnels was used, fixed to a femoral and tibial post with screws and with buttons, respectively. A material testing system (Instron) was used for anteriorly translating the tibia until failure. The femoral and tibial post as a fixation method is superior to the conventional buttons technique. The more anatomical double-bundle reconstruction technique provided significantly higher structural properties and smaller loss of fixation compared with the single-bundle reconstruction technique. The comparison of the two techniques gave superior results to the femoral and tibial screws over the buttons. The double-bundle technique attempts to restore the anterior stability of the knee joint.

Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Comparison of fixation methods of double-bundle double-tibial tunnel ACL reconstruction and double-bundle single-tunnel technique

Kalliakmanis

International Orthopaedics (SICO

et al. 2007

“…Post-traumatic arthritis was noticed in some of our experimental animals during our previous investigations [19,24], but that could be attributed either to the ACL injury or to the surgical procedure itself. Nevertheless, we have not noticed any such case in our present series.…”

Section: Discussionmentioning

confidence: 99%

“…Average age = 23.7 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) years. The left knee was involved 6 times and the right knee 12 times.…”

Section: Methodsmentioning

confidence: 99%

Arthroscopic ACL reconstruction with Δ plasty: an innovative approach with hamstrings’ transfer and double tibial tunnel

Knee Surg Sports Traumatol Arthr

Sourlas

Plessas

et al. 2007

We propose a new technique, with double bundle, double tibial tunnels with a bridge between them, using the hamstrings as auto-grafts, retaining either their central or peripheral attachment. A prospective series of 41 patients underwent primary reconstruction of the anterior cruciate ligament by one surgeon, arthroscopically and electronically assisted; 37 were men and 4 were women with a mean age of 24.7 years. The mean follow-up was 19.05 (12-30) months. Normal function and joint stability was achieved. The patients returned to full occupational activities within 3-6 months after the operation. The function of hamstrings was not disturbed. Two patients have sustained a new injury without rupture of the grafts. The Noulis-Lachman test was negative in 35 knees. Positive Pivot shift, post-operatively, was present in 15.45% of patients. The IKDC score was 84.55. In the proposed ACL reconstruction technique, the two tendons are transferred and used as grafts, with gracillis and semitendinosus retaining their distal and central attachment, respectively; the former superimposed upon the latter while entering the femoral tunnel. The tibial tunnels leave a bone bridge ranging between 12 and 15 mm within the footprints of ACL. The two bundles are tensioned, each at different angle. This configuration imitates both the anatomy and the function of ACL and controls not only the anterior translation, but also the rotatory stability. With this innovative technique, the final outcome is improved, thus being closer to normal, as evidenced from previous experiments and the present prospective series.

“…We consider that the developing of an ACL reconstruction technique that use semitendinosus not as a free autograft but as a graft that retains its natural attachment [33][34][35][36] may be more effective than the techniques that use free hamstrings autografts.…”

Section: Discussionmentioning

confidence: 99%

ACL reconstruction with semitendinosus tendon autograft without detachment of its tibial insertion: a histologic study in a rabbit model

Knee Surg Sports Traumatol Arthr

Nikolaou

Efstathopoulos

et al. 2007

The purpose of this study was to evaluate the histologic changes that occur between 3 and 12 weeks in an intra-articular, semitendinosus autograft, which was harvested without detachment of its tibial insertion and was placed through tibial and femoral drill holes, in a rabbit model. About 30 New Zealand white rabbits underwent ACL replacement using a semitendinosus tendon autograft. The normal ACL was transected at its femoral and tibial insertions. The tendon graft was harvested without detachment of its tibial insertion and its free end was secured with sutures. The graft was then passed through one tibial and one femoral tunnel and secured at the lateral femoral condyle. All animals were divided into three groups and were killed at 3, 6 and 12 weeks after surgery. Nine more animals underwent ACL reconstruction using a free semitendinosus tendon autograft. These animals were used as controls. The intra-articular portion of the graft and the interface between the bone tunnel and the graft was evaluated postoperatively for gross morphology and histological appearance. Results of this study showed that in a rabbit model the semitendinosus tendon autograft retained its viability when harvested without detachment of its peripheral insertion. On contrary, at the control group, necrosis of the graft was observed 3 weeks after surgery and progressively revascularization and maturation occurred 6 and 12 weeks after surgery. Retaining the tibial insertion of the semitendinosus autograft seems to preserves its viability and bypasses the stages of avascular necrosis and revascularization that occurs with the use of a free tendon autograft.