Effect of Single-Bundle and Double-Bundle Anterior Cruciate Ligament Reconstructions on Pivot-Shift Kinematics in Anterior Cruciate Ligament– and Meniscus-Deficient Knees
Restricted accessResearch articleFirst published online February, 2011
Effect of Single-Bundle and Double-Bundle Anterior Cruciate Ligament Reconstructions on Pivot-Shift Kinematics in Anterior Cruciate Ligament– and Meniscus-Deficient Knees
Background: Recent laboratory and clinical studies report no difference between single-bundle (SB) and double-bundle (DB) anterior cruciate ligament (ACL) reconstruction.
Hypothesis: Anatomical DB ACL reconstruction would restore knee kinematics in a complex injury model of ACL–meniscus injury closer to the intact state when compared with 2 common SB ACL reconstructions.
Study Design: Controlled laboratory study.
Methods: Five fresh-frozen cadaveric hip-to-toe lower extremity specimens were used for this study (10 knees). A surgical navigation system recorded the 3-dimensional motion path of a tracked point at the center of the medial and lateral compartments during a 68-N Lachman test and a mechanized pivot-shift test. Testing was performed on the intact knee, after ACL, medial meniscus, and lateral meniscus resection and after 3 ACL reconstructions: anatomical anteromedial SB, nonanatomical SB (posterolateral tibia to anteromedial femur), and anatomical DB. Same-sized hamstring grafts were used for all reconstructions. Repeated-measures analysis of variance with a post hoc Tukey multiple-comparison test was used to compare the anterior tibial translations of the 3 grafts during laxity testing.
Results: Regarding the Lachman test, there was no difference between the anatomical anteromedial SB and DB reconstructions. For the mechanized pivot shift, anatomical DB reconstruction restored anterior tibial translation to the intact state; however, significantly greater anterior tibial translation was detected after anatomical anteromedial SB and nonanatomical SB reconstruction, compared with the intact knee. In addition, there was no difference in medial compartment translations during the pivot shift between the intact and reconstructed states.
Conclusion: Anatomical DB ACL reconstruction was able to restore intact knee kinematics during the pivot shift even in the severe injury model.
Clinical Relevance: Double-bundle ACL reconstruction procedures may be preferred in cases of high-grade instability or meniscus deficiency.
AgliettiPGironFLoscoMCuomoPCiardulloAMondanelliN. Comparison between single- and double-bundle anterior cruciate ligament reconstruction: a prospective, randomized, single-blinded clinical trial. Am J Sports Med. 2010;38(1):25-34.
2.
BachBRJrWarrenRFWickiewiczTL. The pivot shift phenomenon: results and description of a modified clinical test for anterior cruciate ligament insufficiency. Am J Sports Med. 1988;16(6):571-576.
3.
BediAMusahlVLaneCCitakMWarrenRFPearleAD. Lateral compartment translation predicts the grade of pivot shift: a cadaveric and clinical analysis. Knee Surg Sports Traumatol Arthrosc. 2010;18(9):1269-1276.
4.
BediAMusahlVO’LoughlinPF. A comparison of the effect of central anatomical single-bundle anterior cruciate ligament reconstruction and double-bundle anterior cruciate ligament reconstruction on pivot-shift kinematics [published online ahead of print June 21, 2010]. Am J Sports Med.
5.
CannonWDJrVittoriJM. The incidence of healing in arthroscopic meniscal repairs in anterior cruciate ligament-reconstructed knees versus stable knees. Am J Sports Med. 1992;20(2):176-181.
6.
ColombetPRobinsonJChristelPFranceschiJPDjianP. Using navigation to measure rotation kinematics during ACL reconstruction. Clin Orthop Relat Res. 2007;454:59-65.
DeHavenKE. Diagnosis of acute knee injuries with hemarthrosis. Am J Sports Med. 1980;8(1):9-14.
9.
GalwayHRMacIntoshDL. The lateral pivot shift: a symptom and sign of anterior cruciate ligament insufficiency. Clin Orthop Relat Res. 1980;147:45-50.
10.
HarnerCDPoehlingGG. Double bundle or double trouble?Arthroscopy. 2004;20(10):1013-1014.
11.
IrrgangJJBostJEFuFH. Re: outcome of single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: a meta-analysis. Am J Sports Med. 2009;37(2):421-422.
12.
JarvelaTMoisalaASSihvonenRJarvelaSKannusPJarvinenM. Double-bundle anterior cruciate ligament reconstruction using hamstring autografts and bioabsorbable interference screw fixation: prospective, randomized, clinical study with 2-year results. Am J Sports Med. 2008;36(2):290-297.
13.
JohnsonRJKettelkampDBClarkWLeavertonP. Factors effecting late results after meniscectomy. J Bone Joint Surg Am. 1974;56(4):719-729.
14.
KwanMKLinTHWooSL. On the viscoelastic properties of the anteromedial bundle of the anterior cruciate ligament. J Biomech. 1993;26(4-5):447-452.
15.
LaneCGWarrenRFStanfordFCKendoffDPearleAD. In vivo analysis of the pivot shift phenomenon during computer navigated ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2008;16(5):487-492.
16.
LevyIMTorzilliPAWarrenRF. The effect of medial meniscectomy on anterior-posterior motion of the knee. J Bone Joint Surg Am. 1982;64(6):883-888.
17.
LewisPBParameswaranADRueJPBachBRJr. Systematic review of single-bundle anterior cruciate ligament reconstruction outcomes: a baseline assessment for consideration of double-bundle techniques. Am J Sports Med. 2008;36(10):2028-2036.
18.
LubowitzJHPoehlingGG. Techniques in double-bundle anterior cruciate ligament reconstruction: as simple as ABC, or putting the cart before the horse?Arthroscopy. 2008;24(10):1089-1091.
19.
MeredickRBVanceKJApplebyDLubowitzJH. Outcome of single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: a meta-analysis. Am J Sports Med. 2008;36(7):1414-1421.
20.
MonacoELabiancaLConteducaFDe CarliAFerrettiA. Double bundle or single bundle plus extraarticular tenodesis in ACL reconstruction? A CAOS study. Knee Surg Sports Traumatol Arthrosc. 2007;15(10):1168-1174.
21.
MusahlVCitakMO’LoughlinPChoiDBediAPearleA. The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligament-deficient knee [published online ahead of print June 8, 2010]. Am J Sports Med.
22.
MusahlVVoosJChoiD. Comparing stability of different single and double bundle ACL reconstruction techniques: a cadaveric study using navigation. Arthroscopy. In press.
23.
MusahlVVoosJO’LoughlinPFStueberVKendoffDPearleAD. Mechanized pivot shift test achieves greater accuracy than manual pivot shift test [published online ahead of print December 15, 2009]. Knee Surg Sports Traumatol Arthrosc.
24.
NeyretPDonellSTDejourH. Results of partial meniscectomy related to the state of the anterior cruciate ligament: review at 20 to 35 years. J Bone Joint Surg Br. 1993;75(1):36-40.
25.
NoyesFRBassettRWGroodESButlerDL. Arthroscopy in acute traumatic hemarthrosis of the knee: incidence of anterior cruciate tears and other injuries. J Bone Joint Surg Am. 1980;62(5):687-695.
26.
PearleADSolomonDJWanichT. Reliability of navigated knee stability examination: a cadaveric evaluation. Am J Sports Med. 2007;35(8):1315-1320.
27.
RistanisSStergiouNSiaravaENtouliaAMitsionisGGeorgoulisAD. Effect of femoral tunnel placement for reconstruction of the anterior cruciate ligament on tibial rotation. J Bone Joint Surg Am. 2009;91(9):2151-2158.
28.
ShenWForsytheBInghamSMHonkampNJFuFH. Application of the anatomic double-bundle reconstruction concept to revision and augmentation anterior cruciate ligament surgeries. J Bone Joint Surg Am. 2008;90(suppl 4):20-34.
29.
TashmanSCollonDAndersonKKolowichPAnderstW. Abnormal rotational knee motion during running after anterior cruciate ligament reconstruction. Am J Sports Med. 2004;32(4):975-983.
30.
ZantopTDiermannNSchumacherTSchanzSFuFHPetersenW. Anatomical and nonanatomical double-bundle anterior cruciate ligament reconstruction: importance of femoral tunnel location on knee kinematics. Am J Sports Med. 2008;36(4):678-685.
31.
ZantopTWellmannMFuFHPetersenW. Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction: anatomic and radiographic findings. Am J Sports Med. 2008;36(1):65-72.
