Inflammatory response to intraarticular suture placement in anatomic anterior cruciate ligament double-bundle reconstruction: A case report

Double-bundle ACL reconstruction: how big is the learning curve?

The study aim was to determine whether an experienced ACL surgeon could convert from a single-bundle to a double-bundle technique with relative accuracy. We also wanted to determine whether there was a significant learning curve. Ten double-bundle ACL reconstruction procedures were carried out on suitable individuals. Following the procedure, all patients underwent a CT scan of the relevant knee. Femoral and tibial tunnel locations were then measured and compared to reference anatomical locations previously described in the literature. The results were not known to the surgeon until all 10 cases were completed. The total percentage difference between the sum of all four study tunnel locations from their reference anatomical positions was calculated for each patient to assess overall accuracy in tunnel placement. Surgical time and all complications were recorded. There were no complications. The surgical time for patient 1 was 125 min and 65 min for patient 10. There was a tendency to place the anteromedial tunnel on the femur more distal than its anatomical location. The femoral posterolateral tunnel position was placed distal to its anatomical location in all cases. As a consequence, it was also slightly anterior compared to its anatomical location. Accurate tibial tunnel placement was achieved for both the AM and the PL tunnels. An improvement in tunnel placement was observed over the 10 cases. This present study shows that it is possible for an experienced ACL surgeon to convert from a transtibial single-bundle technique to a medial portal double-bundle reconstruction with relative accuracy.

Systematic review of single-bundle anterior cruciate ligament reconstruction outcomes: a baseline assessment for consideration of double-bundle techniques

BACKGROUND

There is increasing interest in comparing the efficacy of single-bundle versus double-bundle anterior cruciate ligament reconstruction. Challenging this comparison, however, has been the lack of an established consensus on the success of single-bundle reconstruction.

HYPOTHESIS

The current outcomes of single-bundle reconstruction can be clarified from a large unbiased body of evidence for future comparisons with double-bundle reconstructions.

STUDY DESIGN

Systematic review.

METHODS

A systematic review of 11 randomized, controlled trials comparing patellar tendon and hamstring tendon grafting is reported. The respective outcomes of each group were combined to assist the orthopaedic surgeon in assessing the current success of single-bundle reconstruction. The primary factors assessed were tibial subluxation and side-to-side differences in laxity. Secondary outcomes included concomitant injuries and treatments, complications, graft failure, range of motion, and radiographic evidence of degenerative changes.

RESULTS

In this review of 1024 single-bundle anterior cruciate ligament reconstructions, 495 concomitant meniscal tears, 95 chondral injuries, and 2 posterior cruciate ligament tears were noted. The complication rate was 6%, and graft failure 4%. Reported pivot-shift test results were negative in 81% of cases; reported Lachman tests were negative in 59% cases; and KT-1000 arthrometer side-to-side differences were <or= 5 mm in 86% of cases. Flexion and extension deficits were reported in 9 of 11 studies through mean range of motion or deficit ranges. Radiographic changes of articular surface abnormalities were observed in 7% of the knees at follow-up investigation.

CONCLUSION

Systematic review of a significant body of unbiased outcome data on single-bundle anterior cruciate ligament reconstruction demonstrates it to be a safe, consistent surgical procedure affording reliable results.

CLINICAL RELEVANCE

These results may be used to assist orthopaedic surgeons in evaluating the benefit and practicality of pursuing new anterior cruciate ligament reconstruction techniques over standard single-bundle anterior cruciate ligament reconstruction.

Anatomic double bundle ACL reconstruction: a literature review

With the abundance of anatomic double bundle ACL reconstruction techniques that currently exist and limited patient outcome data, one has to ask whether or not they should be used and if so, which one, and what is the learning curve for the average knee surgeon to become competent with the technique that they select? The purpose of this literature review is to summarize existing anatomic double bundle ACL reconstruction surgical and rehabilitation techniques and the clinical and biomechanical study evidence that currently exists. In choosing to perform anatomic double bundle ACL reconstruction we suggest that the knee surgeon should look for evidence of: (1) control of the pivot shift phenomenon, (2) improved transverse plane rotatory knee control during the performance of sports type movements, (3) a decreased likelihood of revision procedures either for ACL reconstruction or for treatment of associated primary or recurrent meniscal injuries, (4) improved patient self-reports of perceived function, satisfaction, and quality of life, and (5) radiographic evidence of a lower incidence and/or magnitude of osteoarthritic changes compared to conventional single bundle ACL reconstruction.