Two-bundle, four-tunnel anterior cruciate ligament reconstruction

Abstract

We reviewed 33 patients who underwent anterior cruciate ligament (ACL) reconstruction using a two-bundle, four-tunnel technique. The posterolateral bundle (PLB) and anteromedial bundle (AMB) were individually reconstructed with gracilis and semitendinosus tendon auto-grafts, respectively, using separate tibial and femoral tunnels. At final follow-up (24 months post surgery, range 18-31) the International Knee Documentation Committee's (IKDC) objective final evaluation scores were 69 A, 19 B, 12% C. The mean global subjective IKDC score was 86+/-12 points. Ninety-four percent of the patients had returned to sport after an average of 9 months following surgery and 75% returned to their preinjury sporting level. One patient had suffered a graft rupture as a result of a further sports injury. Eighty-four percent of the patients had a negative pivot shift (IKDC A), 9% a glide (IKDC B), and 6% a "clunk" (IKDC C). The mean postoperative side-to-side laxity, measured with KT1000 arthrometry at manual maximum, was 0.9 mm (SD 1.9). Eighty-one percent of the patients had less than 3 mm difference, with only one patient having greater than 5 mm. Our early experience with this new technique appears to demonstrate satisfactory results that are at least equivalent to other techniques and show an apparent trend towards improved control of anterior laxity.

Objective Criteria for Return to Athletics After Anterior Cruciate Ligament Reconstruction and Subsequent Reinjury Rates: A Systematic Review

“…The failure rate ranged from 0% to 3% in 7 studies, 7,10,17,19,20,25,26 from 4% to 6% in 6 studies, 9,11,12,21,22,27 from 7% to 10% in 4 studies, [13][14][15][16] and from 14% to 24% in 4 studies. 8,18,23,24 Fourteen studies [7][8][9][10][11][14][15][16][17][18][19][20]23,26 (67%) reported no injuries in the contralateral ACL, but in the other 7 studies, 12,13,21,22,24,25,27 the rates of contralateral ACL injuries ranged from 2% to 15%.…”

The double‐bundle technique for anterior cruciate ligament reconstruction: a systematic overview

“…Muneta et al (1999; 54 DBT) could point out a trend in improved anterior stability with the DBT, compared with earlier results with SBT from the same surgeon. Colombet et al (2006; 33 DBT) demonstrated that results with DBT are at least equivalent to those with SBT and showed an apparent trend toward improved control of anterior laxity.…”

Kinematics of the Anterior Cruciate Ligament During Gait

“…17,18,40 The reciprocal function between the 2 bundles has been a rationale for tensioning strategies of grafts in double-bundle ACL reconstructions. 10,45 However, some recent studies could not confirm the reciprocal function between the AM and PL bundles. 21,35,43 Jordan et al 21 found that the AM and PL bundles of ACL played a more important role in low flexion angles, with the 2 bundles reaching maximum length near extension and reducing length with flexion during weightbearing knee flexion.…”