Reconstruction of the ACL with a semitendinosus tendon graft: a prospective randomized single blinded comparison of double-bundle versus single-bundle technique in male athletes

Abstract

Anterior cruciate ligament (ACL) reconstruction in double-bundle technique is advocated to more closely restore the anatomy and function of the native ligament than conventional single-bundle technique. But up to now there are only a few clinical investigations comparing both techniques in a prospective manner. We hypothesized that double-bundle ACL reconstruction reveals superior clinical and subjective results compared to single-bundle technique in a high-demand collective. A total of 50 male patients (mean age 29.4 years) were prospectively randomized consecutively into one of the two reconstruction techniques. Group 1 (SB) underwent a 4-stranded single-bundle reconstruction with a ST graft in femoral position at 10:00 and 02:00 o'clock, respectively. In group 2 (DB), reconstruction was performed by using a 2-stranded ST graft with double-bundle, four tunnel technique. Before surgery and at a 2 year follow-up (range 23-25 months) patients were evaluated by the same blinded observer. There was no significant difference in the side-to-side anterior laxity-measurement with the KT-1000 between both groups. As evaluated by the pivot shift, no significant correlation could be noted (Fisher exact test P = 0.098) between rotational stability and any of the both reconstruction techniques. However, the anterior and rotational stability improved significantly at 2-year follow-up compared to preoperatively (P = 0.003) in both groups. The statistical analysis showed a significant increase for the IKDC (subjective, objective) and the Lysholm Score at final follow-up among each single technique, while we found no significant difference between the two reconstruction methods. On the basis of our investigation, we conclude that reconstruction of the ACL by a double-bundle ST graft with an extracortical anchorage can achieve excellent clinical results. But in contrast to our initial hypothesis, we could not quote any significant advantages by creating two independent bundles. Reconstruction of the anterior cruciate ligament in conventional single-bundle technique with a more horizontal femoral tunnel placement obtains comparable clinical results in the present high-demand collective.

A Pilot Study of Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction With Ligament Remnant Tissue Preservation

“…Furthermore, we compared the results of the present study (Table 1) with those of our conventional anatomic double-bundle ACL reconstruction without remnant preserving. In our previous study, 25 the side-to-side anterior laxity was 1.2 +/-1.9 mm. The postoperative pivot-shift test showed the negative result in 81%, 16 % were rated as +, and 3 % were evaluated as ++.…”

“…25,29 We used an air tourniquet in all cases. After harvesting the semitendinosus tendon, we inserted a guide wire for the tibial PL tunnel using a Wire-navigator® device (Smith & Nephew Japan Inc., Tokyo, Japan), which was developed for the trans-tibial tunnel technique.…”

“…Each tendon was doubled over, and a commercially available polyester tape (Leeds-Keio Artificial Ligament, Neoligament Inc., U.K.) was mechanically connected at an un-looped end of the doubled tendons, using the previously reported technique 25,29 ( Fig. 6).…”

“…The pivot-shift results were evaluated according to a guideline reported in the previous studies. 17,25 The Lysholm knee score (maximum score, 100 points) 32 and the International Knee Documentation Committee (IKDC) form 33 were used. Peak isokinetic torque of the quadriceps and the hamstrings was measured at 60° per second of angular velocity using Cybex II (Lumex, Ronkonkoma, NY, USA) in both knees before and after surgery.…”

“…[11][12][13][14][15][16] On the other hand, only a clinical report 17 has introduced a remnant-preserving technique for double-bundle ACL reconstruction, in which 2 femoral tunnels and one tibial tunnel were made, although anatomic double bundle ACL reconstruction procedures have recently attracted notice because of biomechanical advantages in laboratory studies. [18][19][20][21][22][23][24][25][26][27][28] However, no previous studies have shown clinical evidence about utility of the ACL remnant tissue preservation in ACL reconstruction as of yet. To verify whether preservation of the ACL remnant tissue can really improve proprioceptive functions and enhance revascularization, we should conduct a randomized comparative trial with a sufficient number of patients to compare the 2 ACL reconstruction procedures with and without the remnant preservation in terms of proprioception and revascularization of the graft.…”