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.	羅浩, 敖英芳, 王海軍, 等. 膝關節前交叉韌帶前內束和后外束股骨止點位置的解剖研究. 中華關節外科雜志(電子版), 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.	周敬濱, Zachary W, Carola F, 等. 前交叉韌帶解剖重建理念與方法. 中國運動醫學雜志, 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.	李彥林, 許鵬, 韓睿, 等. 基于MRI二維影像下股骨髁間窩的三維可視化研究. 中國修復重建外科雜志, 2012, 26(10):1182-1186.
15.	許鵬, 李彥林, 陳文棟, 等. MRI影像下股骨髁間窩三維數字化解剖學數據與實體解剖測量值的差異. 中國組織工程研究及臨床康復, 2011, 43(10):8006-8009.
16.	何川, 李彥林, 張振光, 等. 計算機術前規劃軟件輔助前交叉韌帶重建的療效觀察. 中國修復重建外科雜志, 2013, 27(12):1432-1436.
17.	陳文棟, 李彥林, 許鵬, 等. 正常人與尸體膝關節MRI二維圖像重建前交叉韌帶三維模型的比較研究. 中國修復重建外科雜志, 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. 羅浩, 敖英芳, 王海軍, 等. 膝關節前交叉韌帶前內束和后外束股骨止點位置的解剖研究. 中華關節外科雜志(電子版), 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. 周敬濱, Zachary W, Carola F, 等. 前交叉韌帶解剖重建理念與方法. 中國運動醫學雜志, 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. 李彥林, 許鵬, 韓睿, 等. 基于MRI二維影像下股骨髁間窩的三維可視化研究. 中國修復重建外科雜志, 2012, 26(10):1182-1186.
15. 許鵬, 李彥林, 陳文棟, 等. MRI影像下股骨髁間窩三維數字化解剖學數據與實體解剖測量值的差異. 中國組織工程研究及臨床康復, 2011, 43(10):8006-8009.
16. 何川, 李彥林, 張振光, 等. 計算機術前規劃軟件輔助前交叉韌帶重建的療效觀察. 中國修復重建外科雜志, 2013, 27(12):1432-1436.
17. 陳文棟, 李彥林, 許鵬, 等. 正常人與尸體膝關節MRI二維圖像重建前交叉韌帶三維模型的比較研究. 中國修復重建外科雜志, 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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