TY - JOUR
T1 - Single-Tunnel Double-Bundle Anterior Cruciate Ligament Reconstruction with Anatomical Placement of Hamstring Tendon Graft
AU - Gadikota, Hemanth R.
AU - Wu, Jia Lin
AU - Jong Keun Seon, Keun Seon
AU - Sutton, Karen
AU - Gill, Thomas J.
AU - Li, Guoan
N1 - Publisher Copyright:
© 2010 The Author(s).
PY - 2010/4/1
Y1 - 2010/4/1
N2 - Background: Anatomical reconstruction techniques that can restore normal joint kinematics without increasing surgical complications could potentially improve clinical outcomes and help manage anterior cruciate ligament injuries more efficiently. Hypothesis: Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft can more closely restore normal knee anterior-posterior, medial-lateral, and internal-external kinematics than can conventional single-bundle anterior cruciate ligament reconstruction. Study Design: Controlled laboratory study. Methods: Kinematic responses after single-bundle anterior cruciate ligament reconstruction and single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft were compared with the intact knee in 9 fresh-frozen human cadaveric knee specimens using a robotic testing system. Kinematics of each knee were determined under an anterior tibial load (134 N), a simulated quadriceps load (400 N), and combined torques (10 N·m valgus and 5 N·m internal tibial torques) at 0°, 15°, 30°, 60°, and 90° of flexion. Results: Anterior tibial translations were more closely restored to the intact knee level after single-tunnel double-bundle reconstruction with anatomical placement of hamstring tendon graft than with a single-bundle reconstruction under the 3 external loading conditions. Under simulated quadriceps load, the mean internal tibial rotations after both reconstructions were lower than that of the anterior cruciate ligament - intact knee with no significant differences between these 3 knee conditions at 0° and 30° of flexion (P >.05).The increased medial tibial shifts of the anterior cruciate ligament - deficient knees were restored to the intact level by both reconstruction techniques under the 3 external loading conditions. Conclusion: Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft can better restore the anterior knee stability compared with a conventional single-bundle reconstruction. Both reconstruction techniques are efficient in restoring the normal medial-lateral stability but overcorrect the internal tibial rotations. Clinical Relevance: Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft could provide improved clinical outcomes over a conventional single-bundle reconstruction.
AB - Background: Anatomical reconstruction techniques that can restore normal joint kinematics without increasing surgical complications could potentially improve clinical outcomes and help manage anterior cruciate ligament injuries more efficiently. Hypothesis: Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft can more closely restore normal knee anterior-posterior, medial-lateral, and internal-external kinematics than can conventional single-bundle anterior cruciate ligament reconstruction. Study Design: Controlled laboratory study. Methods: Kinematic responses after single-bundle anterior cruciate ligament reconstruction and single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft were compared with the intact knee in 9 fresh-frozen human cadaveric knee specimens using a robotic testing system. Kinematics of each knee were determined under an anterior tibial load (134 N), a simulated quadriceps load (400 N), and combined torques (10 N·m valgus and 5 N·m internal tibial torques) at 0°, 15°, 30°, 60°, and 90° of flexion. Results: Anterior tibial translations were more closely restored to the intact knee level after single-tunnel double-bundle reconstruction with anatomical placement of hamstring tendon graft than with a single-bundle reconstruction under the 3 external loading conditions. Under simulated quadriceps load, the mean internal tibial rotations after both reconstructions were lower than that of the anterior cruciate ligament - intact knee with no significant differences between these 3 knee conditions at 0° and 30° of flexion (P >.05).The increased medial tibial shifts of the anterior cruciate ligament - deficient knees were restored to the intact level by both reconstruction techniques under the 3 external loading conditions. Conclusion: Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft can better restore the anterior knee stability compared with a conventional single-bundle reconstruction. Both reconstruction techniques are efficient in restoring the normal medial-lateral stability but overcorrect the internal tibial rotations. Clinical Relevance: Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft could provide improved clinical outcomes over a conventional single-bundle reconstruction.
KW - anatomical single-tunnel double-bundle reconstruction
KW - anterior cruciate ligament (ACL)
KW - knee kinematics
KW - robotic testing system
KW - single-bundle reconstruction
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U2 - 10.1177/0363546509353406
DO - 10.1177/0363546509353406
M3 - Article
C2 - 20139332
AN - SCOPUS:77954724169
SN - 0363-5465
VL - 38
SP - 713
EP - 720
JO - American Journal of Sports Medicine
JF - American Journal of Sports Medicine
IS - 4
ER -