EFFECTIVENESSES OF SINGLE-BUNDLE AND DOUBLE-BUNDLE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION BY TWO METHODS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YUYang ,  LIYanlin , WANGGuoliang , JIADi , GAOHuanyu , WANGKun , XIAOYu

Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China;

Corresponding author：

LIYanlin, Email: 852387873@qq.com

Keywords：

Anterior cruciate ligament; Anatomical reconstruction; Individualized reconstruction; Threedimensional model

DOI：

10.7507/1002-1892.20150263

Video：

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Objective To compare the effectiveness of single-bundle and double-bundle anterior cruciate ligament (ACL) reconstruction by two methods. Methods Qualified for the selective standard, 120 patients with ACL injury between May 2010 and April 2013 were divided into 4 groups: double-bundle reconstruction was performed by the conventional procedure in 30 cases (group A); anatomic double-bundle reconstruction was performed in the original ACL residual footprints in 30 cases (group B); single-bundle reconstruction was performed by the conventional procedure in 30 cases (group C); and anatomic single-bundle reconstruction was performed in the original ACL residual footprints in 30 cases (group D). There was no significant difference in gender, age, disease duration, pathogenesis, injury side, Lysholm scores, International Knee Documentation Committee (IKDC) ratings, Lachman test, anterior drawer test, and pivot shift test among groups (P>0.05). The impingement between the ACL implants and intercondylar notch was evaluated with postoperative immediate MRI scan and the three-dimensional digital model. Lachman test, anterior drawer test, and pivot shift test results, Lysholm scores, and IKDC ratings were used to compare the effectiveness among groups after operation. Results Three-dimensional digital model after operation showed impingement in 11 cases (36.7%) of group A, 1 case (3.3%) of group B, 9 cases (30.0%) of group C, and no impingement in group D. The impingement rates of groups A and C were significantly higher than that of groups B and D (P<0.05), but no significant difference was found between groups A and C, and between groups B and D (P>0.05). All incisions healed by first intention, and no early complication was found. The patients were followed up 24-30 months (mean, 26 months). Lysholm scores, Lachman test, anterior drawer test, and pivot shift test results at 24 months after operation were significantly better than preoperative ones in 4 groups (P<0.05), but no significant difference was shown among groups (P>0.05). The IKDC ratings of groups B and D were significantly better than that of groups A and C (P<0.05); but there was no significant difference between groups A and C, and between groups B and D (P>0.05). Conclusion Compared with the conventional procedure, the individual anatomic single- and double-bundle reconstruction in the original ACL residual footprints has decreased impingement rate and increased IKDC rating.

Citation： YUYang, LIYanlin, WANGGuoliang, JIADi, GAOHuanyu, WANGKun, XIAOYu. EFFECTIVENESSES OF SINGLE-BUNDLE AND DOUBLE-BUNDLE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION BY TWO METHODS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(10): 1208-1213. doi: 10.7507/1002-1892.20150263 Copy

1.	McConkey MO, Amendola A, Ramme AJ, et al. Arthroscopic agreement among surgeons on anterior cruciate ligament tunnel placement. Am J Sports Med, 2012, 40(12):2737-2746.
2.	Tompkins M, Cosgrove CT, Milewski MD, et al. Anterior cruciate ligament reconstruction femoral tunnel characteristics using an accessory medial portal versus traditional transtibial drilling. Arthroscopy, 2013, 29(3):550-555.
3.	罗浩, 敖英芳, 王海军, 等. 膝关节前交叉韧带前内束和后外束股骨止点位置的解剖研究. 中华关节外科杂志(电子版), 2012, 6(1): 97-103.
4.	Siebold R, Ellert T, Metz S, et al. Tibial insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament:morphometry, arthroscopic landmarks, and orientation model for bone tunnel placement. Arthroscopy, 2008, 24(2):154-161.
5.	周敬滨, Zachary W, Carola F, 等. 前交叉韧带解剖重建理念与方法. 中国运动医学杂志, 2011, 30(6):511-518.
6.	Giuliani JR, Kilcoyne KG, Rue JP. Anterior cruciate ligament anatomy:a review of the anteromedial and posterolateral bundles. J Knee Surg, 2009, 22(2):148-154.
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8.	Takahashi M, Doi M, Abe M, et al. Anatomical study of the femoral and tibial insertions of the anteromedial and posterolateral bundles of human anterior cruciate ligament. Am J Sports Med, 2006, 34(5): 787-792.
9.	Adachi N, Ochi M, Uchio Y, et al. Reconstruction of the anterior cruciate ligament. Single-versus double-bundle multistranded hamstring tendons. J Bone Joint Surg (Br), 2004, 86(4):515-520.
10.	Streich NA, Friedrich K, Gotterbarm T, et al. 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. Knee Surg Sports Traumatol Arthrosc, 2008, 16(3):232-238.
11.	Dodin P, Martel-Pelletier J, Pelletier JP, et al. A fully automated human knee 3D MRI bone segmentation using the ray casting technique. Med Biol Eng Comput, 2011, 49(12):1413-1424.
12.	Fujimoto E, Sumen Y, Deie M, et al. Anterior cruciate ligament graft impingement against the posterior cruciate ligament:diagnosis using MRI plus three-dimensional reconstruction software. Magn Reson Imaging, 2004, 22(8):1125-1129.
13.	Petersen W, Tretow H, Weimann A, et al. Biomechanical evaluation of two techniques for double-bundle anterior cruciate ligament reconstruction:one tibial tunnel versus two tibial tunnels. Am J Sports Med, 2007, 35(2):228-234.
14.	李彦林, 许鹏, 韩睿, 等. 基于MRI二维影像下股骨髁间窝的三维可视化研究. 中国修复重建外科杂志, 2012, 26(10):1182-1186.
15.	许鹏, 李彦林, 陈文栋, 等. MRI影像下股骨髁间窝三维数字化解剖学数据与实体解剖测量值的差异. 中国组织工程研究及临床康复, 2011, 43(10):8006-8009.
16.	何川, 李彦林, 张振光, 等. 计算机术前规划软件辅助前交叉韧带重建的疗效观察. 中国修复重建外科杂志, 2013, 27(12):1432-1436.
17.	陈文栋, 李彦林, 许鹏, 等. 正常人与尸体膝关节MRI二维图像重建前交叉韧带三维模型的比较研究. 中国修复重建外科杂志, 2011, 25(11):1314-1318.

1. McConkey MO, Amendola A, Ramme AJ, et al. Arthroscopic agreement among surgeons on anterior cruciate ligament tunnel placement. Am J Sports Med, 2012, 40(12):2737-2746.
2. Tompkins M, Cosgrove CT, Milewski MD, et al. Anterior cruciate ligament reconstruction femoral tunnel characteristics using an accessory medial portal versus traditional transtibial drilling. Arthroscopy, 2013, 29(3):550-555.
3. 罗浩, 敖英芳, 王海军, 等. 膝关节前交叉韧带前内束和后外束股骨止点位置的解剖研究. 中华关节外科杂志(电子版), 2012, 6(1): 97-103.
4. Siebold R, Ellert T, Metz S, et al. Tibial insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament:morphometry, arthroscopic landmarks, and orientation model for bone tunnel placement. Arthroscopy, 2008, 24(2):154-161.
5. 周敬滨, Zachary W, Carola F, 等. 前交叉韧带解剖重建理念与方法. 中国运动医学杂志, 2011, 30(6):511-518.
6. Giuliani JR, Kilcoyne KG, Rue JP. Anterior cruciate ligament anatomy:a review of the anteromedial and posterolateral bundles. J Knee Surg, 2009, 22(2):148-154.
7. Mochizuki T, Muneta T, Nagase T, et al. Cadaveric knee observation study for describing anatomic femoral tunnel placement for twobundle anterior cruciate ligament reconstruction. Arthroscopy, 2006, 22(4):356-361.
8. Takahashi M, Doi M, Abe M, et al. Anatomical study of the femoral and tibial insertions of the anteromedial and posterolateral bundles of human anterior cruciate ligament. Am J Sports Med, 2006, 34(5): 787-792.
9. Adachi N, Ochi M, Uchio Y, et al. Reconstruction of the anterior cruciate ligament. Single-versus double-bundle multistranded hamstring tendons. J Bone Joint Surg (Br), 2004, 86(4):515-520.
10. Streich NA, Friedrich K, Gotterbarm T, et al. 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. Knee Surg Sports Traumatol Arthrosc, 2008, 16(3):232-238.
11. Dodin P, Martel-Pelletier J, Pelletier JP, et al. A fully automated human knee 3D MRI bone segmentation using the ray casting technique. Med Biol Eng Comput, 2011, 49(12):1413-1424.
12. Fujimoto E, Sumen Y, Deie M, et al. Anterior cruciate ligament graft impingement against the posterior cruciate ligament:diagnosis using MRI plus three-dimensional reconstruction software. Magn Reson Imaging, 2004, 22(8):1125-1129.
13. Petersen W, Tretow H, Weimann A, et al. Biomechanical evaluation of two techniques for double-bundle anterior cruciate ligament reconstruction:one tibial tunnel versus two tibial tunnels. Am J Sports Med, 2007, 35(2):228-234.
14. 李彦林, 许鹏, 韩睿, 等. 基于MRI二维影像下股骨髁间窝的三维可视化研究. 中国修复重建外科杂志, 2012, 26(10):1182-1186.
15. 许鹏, 李彦林, 陈文栋, 等. MRI影像下股骨髁间窝三维数字化解剖学数据与实体解剖测量值的差异. 中国组织工程研究及临床康复, 2011, 43(10):8006-8009.
16. 何川, 李彦林, 张振光, 等. 计算机术前规划软件辅助前交叉韧带重建的疗效观察. 中国修复重建外科杂志, 2013, 27(12):1432-1436.
17. 陈文栋, 李彦林, 许鹏, 等. 正常人与尸体膝关节MRI二维图像重建前交叉韧带三维模型的比较研究. 中国修复重建外科杂志, 2011, 25(11):1314-1318.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESSES OF SINGLE-BUNDLE AND DOUBLE-BUNDLE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION BY TWO METHODS

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