Anatomic Double-Bundle Reconstruction Techniques Result in Graft Obliquities That Closely Mimic the Native Anterior Cruciate Ligament Anatomy

Kyung, Bong Soo,Kim, Jae Gyoon,Chang, Minho,Jang, Ki-Mo,Lee, Sung Sahn,Ahn, Jin Hwan,Wang, Joon Ho SAGE Publications 2013 AMERICAN JOURNAL OF SPORTS MEDICINE - Vol.41 No.6

<P><B>Background:</B></P><P>It has been reported previously that single-bundle anterior cruciate ligament (ACL) reconstruction with more accurate restoration of the footprint of the native ACL fails to restore the graft obliquity of the native ACL in the coronal plane. Whether double-bundle ACL reconstruction restores the graft obliquity of each bundle of the native ACL has not yet been determined.</P><P><B>Hypothesis:</B></P><P>Anatomic double-bundle ACL reconstruction using transportal (TP) and outside-in (OI) techniques can restore the graft obliquities of both anteromedial (AM) and posterolateral (PL) bundles in the native ACL in both sagittal and coronal planes.</P><P><B>Study Design:</B></P><P>Cohort study; Level of evidence, 2.</P><P><B>Methods:</B></P><P>Seventy-six patients underwent anatomic double-bundle ACL reconstruction. Patients were randomized to 2 groups to undergo either TP or OI tibial tunnel–independent anatomic ACL reconstruction. All participants underwent postoperative magnetic resonance imaging of both knees, and the native ACL obliquity was determined using the participant’s contralateral knee. Graft obliquities were determined by measuring the angles between the center line of the graft and the surface line of the tibial plateau, and the obliquities of paired knees were compared. Graft obliquities were analyzed in each group.</P><P><B>Results:</B></P><P>In the sagittal plane, the mean AM graft obliquity was 54.2° on the operated side and 54.6° on the nonoperated side, and the difference between sides was not statistically significant (<I>P</I> = .352). The mean PL graft obliquity in the sagittal plane was 54.1° on the operated side and 53.0° on the nonoperated side, and the difference between sides was also not statistically significant (<I>P</I> = .228). In the coronal plane, the mean AM graft obliquity was 73.8° on the operated side and 73.4° on the nonoperated side, and the mean PL graft obliquity was 65.5° on the operated side and 66.4° on the nonoperated side. There were no statistically significant differences between sides (<I>P</I> = .418 for AM graft; <I>P</I> = .328 for PL graft). Differences in the paired graft obliquities in each group were also statistically insignificant between the TP and OI groups.</P><P><B>Conclusion:</B></P><P>Both TP and OI anatomic double-bundle reconstruction techniques can result in graft obliquities in both bundles that resemble the native ACL in both sagittal and coronal planes.</P><P><B>Clinical Relevance:</B></P><P>Double-bundle ACL reconstruction techniques might more closely restore the normal kinematics of the native ACL by restoring the normal obliquity of both ACL bundles.</P>

Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Using an Outside-in Technique: Two- to Six-Year Clinical and Radiological Follow-up

( Jae Ang Sim ),( Yong Seuk Lee ),( Kyung Ok Kim ),( Jong Keun Kim ),( Beom Koo Lee ) 대한슬관절학회 2015 대한슬관절학회지 Vol.27 No.1

Purpose: We evaluated the clinical and radiological outcomes of double-bundle anterior cruciate ligament (ACL) reconstruction using an outside-in technique with a follow-up of two- to six-years, especially in terms of the sports activity level and radiological degeneration. Materials and Methods: Sixty-seven patients who were available for a minimum two-year follow-up after double-bundle ACL reconstruction using an outside-in technique were retrospectively evaluated. The mean follow-up period was 43.7 months. The knee function and stability were evaluated before the operation, one year after the operation (short-term follow-up), and more than two years after the operation (last follow-up).Results: Regarding the knee function, the Lysholm score, International Knee Documentation Committee (IKDC) evaluation, and hop test showed significant improvement. Regarding the stability, the Lachman test, pivot shift test, KT-2000 arthrometer data, and anterior drawer radiographs using Telos showed significant improvement. Regarding the sports activity level, the patients who returned to pre-injury level activity was 68.7% according to the Tegner activity score and 76.1% according to the Cincinnati sports activity scale score. The incidence of aggravated degeneration ordevelopment of greater than IKDC grade A degeneration after surgery was 10.4%. Conclusions: Double-bundle ACL reconstruction using an outside-in technique showed favorable clinical and radiological outcomes with respect to the knee function and stability, joint degeneraion, and, especially, return to pre-injury sports activity.

전방십자인대 이중 다발 재건술

이주홍 ( Ju Hong Lee ) 대한슬관절학회 2009 대한슬관절학회지 Vol.21 No.1

전방십자인대 손상에 대해 일반적으로 시행되는 전방십자인대 단일 다발 재건술은 많은 발전에도 불구하고 슬관절 안정성과 기능 회복에 있어서 적지 않은 비율의 불만족한 결과가 존재하고 있으며 그 임상적 결과를 향상시키기 위한 노력으로서 최근 전방십자인대 이중 다발 재건술에 대한 관심이 증가하고 있다. 전방십자인대 이중 다발 재건술은 단일 다발 재건술에 비해 해부학적, 생역학적, 생물학적, 운동역학적으로 많은 이론적 장점이 있고 이에 따른 임상적 측면에서의 결과 향상이 기대되지만 이를 입증할 만한 충분한 관찰 기간을 가진 임상적 연구들이 매우 부족한 실정이다. 따라서 저자는 전방십자인대 이중다발 재건술에 관련되어 최근까지 발표된 많은 문헌을 통해 이중 다발 술식의 발전 토대를 제공한 과학적 증거들을 정리하고 술식의 유용성 여부를 둘러싼 논란에 대해 알아보았다. A recent growing interest in double-bundle anterior cruciate ligament reconstruction (DBACLR) reflect the effort of producing better clinical outcomes in traditional single-bundle reconstruction, which showed considerable rate of dissatisfaction in restoration of stability and function of the anterior cruciate ligament deficient knee. There is plenty of evidence that DBACLR has theoretical advantages in anatomical, biomechanical, biological, kinematical, and possibly clinical standpoint compared with traditional one but still a lack of available clinical outcome studies with sufficient follow-up to demonstrate the real advantages of DBACLR. The aim of this article is to review the evidence to support double-bundle technique and to address controversy exists over the usefulness of this technique.

Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Using an Outside-in Technique: Two- to Six-Year Clinical and Radiological Follow-up

심재앙,이용석,김경옥,김종근,이범구 대한슬관절학회 2015 대한슬관절학회지 Vol.27 No.1

Purpose: We evaluated the clinical and radiological outcomes of double-bundle anterior cruciate ligament (ACL) reconstruction using an outside-in technique with a follow-up of two- to six-years, especially in terms of the sports activity level and radiological degeneration.Materials and Methods: Sixty-seven patients who were available for a minimum two-year follow-up after double-bundle ACL reconstruction using an outside-in technique were retrospectively evaluated. The mean follow-up period was 43.7 months. The knee function and stability were evaluated before the operation, one year after the operation (short-term follow-up), and more than two years after the operation (last follow-up).Results: Regarding the knee function, the Lysholm score, International Knee Documentation Committee (IKDC) evaluation, and hop test showed significant improvement. Regarding the stability, the Lachman test, pivot shift test, KT-2000 arthrometer data, and anterior drawer radiographs using Telos showed significant improvement. Regarding the sports activity level, the patients who returned to pre-injury level activity was 68.7% according to the Tegner activity score and 76.1% according to the Cincinnati sports activity scale score. The incidence of aggravated degeneration or development of greater than IKDC grade A degeneration after surgery was 10.4%.Conclusions: Double-bundle ACL reconstruction using an outside-in technique showed favorable clinical and radiological outcomes with respect to the knee function and stability, joint degeneraion, and, especially, return to pre-injury sports activity.

Evaluation of Knee Joint after Double-Bundle ACL Reconstruction with Three-Dimensional Isotropic MRI

정민주,정유미,이범구,심재앙,최혜영,김정호,이신우 대한자기공명의과학회 2016 Investigative Magnetic Resonance Imaging Vol.20 No.2

Purpose: To evaluate the knee joint after double-bundle anterior cruciate ligament (ACL) reconstruction with three-dimensional (3D) isotropic magnetic resonance (MR) image, and to directly compare the ACL graft findings on 3D MR with the clinical results. Materials and Methods: From January 2009 to December 2014, we retrospectively reviewed MRIs of 39 patients who had reconstructed ACL with double bundle technique. The subjects were examined using 3D isotropic proton-density sequence and routine two-dimensional (2D) sequence on 3.0T scanner. The MR images were qualitatively evaluated for the intraarticular curvature, graft tear, bony impingement, intraosseous tunnel cyst, and synovitis of anteromedial and posterolateral bundles (AMB, PLB). In addition anterior tibial translation, PCL angle, PCL ratio were quantitatively measured. KT arthrometric values were reviewed for anterior tibial translation as positive or negative. The second look arthroscopy results including tear and laxity were reviewed. Results: Significant correlations were found between an AMB tear on 3D-isotropic proton density MR images and arthroscopic proven AMB tear or laxity (P < 0.05). Also, a significant correlation was observed between increased PCL ratio on 3D isotropic MRI and the arthroscopic findings such as tear, laxities of grafts (P < 0.05). KT arthrometric results were found to be significantly correlated with AMB tears (P < 0.05) and tibial tunnel cysts (P < 0.05). Conclusion: An AMB tear on 3D-isotropic MRI was correlated with arthroscopic results qualitatively and quantitatively. 3D isotropic MRI findings can aid the evaluation of ACL grafts after double bundle reconstruction.

Evaluation of Knee Joint after Double-Bundle ACL Reconstruction with Three-Dimensional Isotropic MRI

Jung, Min ju,Jeong, Yu Mi,Lee, Beom Goo,Sim, Jae Ang,Choi, Hye-Young,Kim, Jeong Ho,Lee, Sheen-Woo Korean Society of Magnetic Resonance in Medicine 2016 Investigative Magnetic Resonance Imaging Vol.20 No.2

Purpose: To evaluate the knee joint after double-bundle anterior cruciate ligament (ACL) reconstruction with three-dimensional (3D) isotropic magnetic resonance (MR) image, and to directly compare the ACL graft findings on 3D MR with the clinical results. Materials and Methods: From January 2009 to December 2014, we retrospectively reviewed MRIs of 39 patients who had reconstructed ACL with double bundle technique. The subjects were examined using 3D isotropic proton-density sequence and routine two-dimensional (2D) sequence on 3.0T scanner. The MR images were qualitatively evaluated for the intraarticular curvature, graft tear, bony impingement, intraosseous tunnel cyst, and synovitis of anteromedial and posterolateral bundles (AMB, PLB). In addition anterior tibial translation, PCL angle, PCL ratio were quantitatively measured. KT arthrometric values were reviewed for anterior tibial translation as positive or negative. The second look arthroscopy results including tear and laxity were reviewed. Results: Significant correlations were found between an AMB tear on 3D-isotropic proton density MR images and arthroscopic proven AMB tear or laxity (P < 0.05). Also, a significant correlation was observed between increased PCL ratio on 3D isotropic MRI and the arthroscopic findings such as tear, laxities of grafts (P < 0.05). KT arthrometric results were found to be significantly correlated with AMB tears (P < 0.05) and tibial tunnel cysts (P < 0.05). Conclusion: An AMB tear on 3D-isotropic MRI was correlated with arthroscopic results qualitatively and quantitatively. 3D isotropic MRI findings can aid the evaluation of ACL grafts after double bundle reconstruction.