Yonsei Med J.  2016 Sep;57(5):1199-1208. 10.3349/ymj.2016.57.5.1199.

A Comparison between Clinical Results of Selective Bundle and Double Bundle Anterior Cruciate Ligament Reconstruction

• Yoo YS
• Song SY
• Yang CJ
• Ha JM
• Kim YS
• Seo YJ

• KMID: 2374166
• DOI: http://doi.org/10.3349/ymj.2016.57.5.1199

Abstract

PURPOSE
The purpose of this study was to compare the clinical outcomes of arthroscopic anatomical double bundle (DB) anterior cruciate ligament (ACL) reconstruction with either selective anteromedial (AM) or posterolateral (PL) bundle reconstruction while preserving a relatively healthy ACL bundle.
MATERIALS AND METHODS
The authors evaluated 98 patients with a mean follow-up of 30.8±4.0 months who had undergone DB or selective bundle ACL reconstructions. Of these, 34 cases underwent DB ACL reconstruction (group A), 34 underwent selective AM bundle reconstruction (group B), and 30 underwent selective PL bundle reconstructions (group C). These groups were compared with respect to Lysholm and International Knee Documentation Committee (IKDC) score, side-to-side differences of anterior laxity measured by KT-2000 arthrometer at 30 lbs, and stress radiography and Lachman and pivot shift test results. Pre- and post-operative data were objectively evaluated using a statistical approach.
RESULTS
The preoperative anterior instability measured by manual stress radiography at 90° of knee flexion in group A was significantly greater than that in groups B and C (all p<0.001). At last follow-up, mean side-to-side instrumented laxities measured by the KT-2000 and manual stress radiography were significantly improved from preoperative data in all groups (all p<0.001). There were no significant differences between the three groups in anterior instability measured by KT-2000 arthrometer, pivot shift, or functional scores.
CONCLUSION
Selective bundle reconstruction in partial ACL tears offers comparable clinical results to DB reconstruction in complete ACL tears.

Keyword

Anterior cruciate ligament; double bundle; selective bundle; reconstruction

MeSH Terms

Adolescent
Adult
Anterior Cruciate Ligament/*surgery
Anterior Cruciate Ligament Reconstruction/*methods
Arthroscopy
Female
Humans
Male
Middle Aged
Organ Sparing Treatments/*methods
Treatment Outcome
Young Adult

Figure

• 

  Fig. 1 Anterolateral (AL), anteromedial (AM), and accessory anteromedial (AAM) portals were established. The AM portal was used as a viewing portal for inspecting femoral ACL insertion sites. Femoral AM and PL bone tunnels were made through the AAM portal. PL, posterolateral; ACL, anterior cruciate ligament.

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  Fig. 2 Arthroscopic view from anteromedial portal. (A) The PL bundle was elongated, but still bridged tibia and femur (PL), although the AM bundle was completely torn (*). Selective AM bundle reconstruction was performed in this case. (B) A completely torn PL bundle was noted (*) by probing an AM bundle that was moderately attenuated (AM). Selective PL bundle reconstruction was conducted in this case. PL, posterolateral; AM, anteromedial.

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  Fig. 3 Arthroscopic view from anterolateral portal. Both AM and PL bundles were absent (arrows). DB ACL reconstruction was conducted in this case. AM, anteromedial; PL, posterolateral; DB, double bundle; ACL, anterior cruciate ligament.

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  Fig. 4 Arthroscopic view from anteromedial portal. (A) The AM graft (AM) was passed after PL graft (PL) fixation during DB ACL reconstruction. (B) Reconstructed AM bundle (AM) and (C) reconstructed PL bundle (PL). AM, anteromedial; PL, posterolateral; DB, double bundle; ACL, anterior cruciate ligament.

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