Highlights
- •Comparing single- and double-bundle anterior cruciate ligament reconstruction.
- •Using laxity-matched pretension and a knee-specific model for dynamic pivot shift.
- •Persistent rotational knee laxity remains following single-bundle reconstruction.
- •Double-bundle reconstruction reduces envelope of rotation to intact knee levels.
- •Both single- and double-bundle methods restore anterior laxity to intact knee levels.
Abstract
Background
To treat anterior cruciate ligament (ACL) injuries, double-bundle ACL reconstruction
has been proposed as a more anatomical approach relative to single-bundle reconstruction.
However, controversy remains over which technique is superior in addressing knee instability,
particularly rotational laxity. We hypothesize that double-bundle reconstruction better
restores rotational knee laxity, while both methods are similar in restoring anterior
knee laxity, to intact knee levels.
Methods
A controlled laboratory study. Eight cadaveric knees were tested accordingly: (1)
static anterior laxity testing under 150 N-anterior tibial loading at 20°, 60° and
90° knee flexion using a material testing machine, followed by (2) dynamic simulated
pivot-shift with knee-specific loading involving iliotibial band forces, valgus and
internal rotation torques, while the knee was brought from extension to 90° flexion
on a 6°-of-freedom custom-designed rig. Tibiofemoral kinematics were recorded using
an electromagnetic tracking system for the ACL-intact, ACL-deficient, single-bundle
and double-bundle ACL-reconstructed knee conditions.
Findings
Double-bundle reconstruction reduced internal rotation under pivot-shift to levels
not significantly different from ACL-intact conditions (P > .173), unlike single-bundle that remained significantly higher at 10–40° flexion
(P < .05). For anterior laxity, there was no significant difference between double-bundle,
single-bundle, and ACL-intact conditions under static testing (P > .175) or pivot-shift (P = .219). The maximum extent of knee envelope laxity was significantly reduced for
double-bundle relative to single-bundle, particularly for the rotatory component (P = .012).
Interpretation
Double-bundle was biomechanically superior to single-bundle in addressing envelope
of rotation, while both techniques restored anterior knee laxity to ACL-intact levels.
Keywords
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Article info
Publication history
Published online: September 03, 2022
Accepted:
August 30,
2022
Received:
August 2,
2021
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
