Arthroscopic reconstruction of anterior cruciate ligaments with allograft: single-tunnel single-bundle versus single-tunnel double-bundle techniques

Anatomic Double-Bundle and Single-Bundle Reconstructions Yield Similar Outcomes Following Anterior Cruciate Ligament Rupture: A Systematic Review and Meta-analysis

PURPOSE

To evaluate outcomes of arthroscopic single-bundle (SB) versus anatomic double-bundle (ADB) anterior cruciate ligament reconstruction (ACLR) in adults through a synthesis of randomized controlled trials (RCTs). We hypothesized that SB and ADB methods would lead to similar outcomes after reconstruction of ACL rupture.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist guided our reporting. To identify RCTs that compared SB and ADB reconstructions, a thorough literature search was conducted of PubMed, Embase, Cochrane library, and Web of Science. The methodologic quality of each included study was independently assessed by 2 authors using the Cochrane Collaboration's risk of bias tool. The Anatomic ACL Reconstruction Scoring Checklist (AARSC) was used to screen the eligibility of each study's operative approaches. Twelve clinical outcomes were investigated through pooled analyses conducted using Review Manager 5.3.

RESULTS

This meta-analysis synthesized 13 RCTs comparing postoperative outcomes between ADB and SB reconstructions of ACLs. After a minimum follow-up of 12 months, ADB and SB technique resulted in similar subjective clinical outcomes, including the International Knee Documentation Committee subjective score, Lysholm score, Tegner activity score, and Knee injury and Osteoarthritis Outcome Score sports subscale. Similarly, no statistically significant outcomes were found for objective outcomes such as International Knee Documentation Committee objective grade, pivot-shift test, Lachman test, side-to-side difference, extension deficit, flexion deficit, and osteoarthritis change. However, patients who underwent SB reconstruction had significantly greater complication rates than those that underwent ADB reconstruction.

CONCLUSIONS

When an ACLR approach meets a minimal total AARSC score of 8, ADB and SB techniques may result in similar subjective and objective outcomes, but the ADB technique may lead to lower complication rates following surgery. We recommend that surgeons favor ADB ACLR, as guided by the AARSC.

LEVEL OF EVIDENCE

Level I, systematic review and meta-analysis of Level I randomized controlled trials.

A novel home-based rehabilitative knee brace system is a viable option for postoperative rehabilitation after anterior cruciate ligament reconstruction: a report of 15 cases

Purpose

To investigate the functional outcomes for patients who used a novel home-based rehabilitative system during the postoperative period after anterior cruciate ligament (ACL) reconstructions.

Methods

Patients undergoing ACL reconstruction surgeries were prospectively enrolled. A home-based rehabilitation system, which is composed of a knee brace with a motion tracker, a mobile app, and a web portal, was applied. Patients could complete the rehabilitation exercise through the audio guidance and the real-time tracking system which displayed the achieved motions on the user interface of the app. Feedbacks from the patients, including the International Knee Documentation Committee (IKDC) scores, were collected and uploaded to the web portal. Each patient would meet a specialized physical therapist face-to-face once a month. At postoperative 6 months, every patient received a GNRB arthrometer examination and a Cybex isokinetic dynamometer examination.

Results

A total of 15 patients (10 males and 5 females) were enrolled and followed for at least 6 months. The mean time of return to full knee extension was 1.5 months.

The mean difference in laxity measured by GNRB arthrometer at 134 N significantly improved at postoperative 6 months (1.8 ± 1.6 mm) compared to that measured preoperatively (3.4 ± 1.9 mm) (p = 0.024). The peak torques of flexor and extensor muscles measured by Cybex isokinetic dynamometer remained unchanged at postoperative 6 months (p = 0.733 and 0.394, respectively). The patients’ IKDC score became smaller at postoperative 1 month (p = 0.011) and significantly improved at postoperative 6 months (p = 0.002).

Conclusion

Using a home-based rehabilitative knee brace system after ACL reconstruction is a viable option as patients maintained their knee muscle strengths maintained their muscle strength and achieve similar or better knee range of motion six months postoperatively.