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, 38 (4), 713-20

Single-tunnel Double-Bundle Anterior Cruciate Ligament Reconstruction With Anatomical Placement of Hamstring Tendon Graft: Can It Restore Normal Knee Joint Kinematics?

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Single-tunnel Double-Bundle Anterior Cruciate Ligament Reconstruction With Anatomical Placement of Hamstring Tendon Graft: Can It Restore Normal Knee Joint Kinematics?

Hemanth R Gadikota et al. Am J Sports Med.

Abstract

Background: Anatomical reconstruction techniques that can restore normal joint kinematics without increasing surgical complications could potentially improve clinical outcomes and help manage anterior cruciate ligament injuries more efficiently.

Hypothesis: Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft can more closely restore normal knee anterior-posterior, medial-lateral, and internal-external kinematics than can conventional single-bundle anterior cruciate ligament reconstruction.

Study design: Controlled laboratory study.

Methods: Kinematic responses after single-bundle anterior cruciate ligament reconstruction and single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft were compared with the intact knee in 9 fresh-frozen human cadaveric knee specimens using a robotic testing system. Kinematics of each knee were determined under an anterior tibial load (134 N), a simulated quadriceps load (400 N), and combined torques (10 N.m valgus and 5 N.m internal tibial torques) at 0 degrees , 15 degrees , 30 degrees , 60 degrees , and 90 degrees of flexion.

Results: Anterior tibial translations were more closely restored to the intact knee level after single-tunnel double-bundle reconstruction with anatomical placement of hamstring tendon graft than with a single-bundle reconstruction under the 3 external loading conditions. Under simulated quadriceps load, the mean internal tibial rotations after both reconstructions were lower than that of the anterior cruciate ligament-intact knee with no significant differences between these 3 knee conditions at 0 degrees and 30 degrees of flexion (P > .05). The increased medial tibial shifts of the anterior cruciate ligament-deficient knees were restored to the intact level by both reconstruction techniques under the 3 external loading conditions.

Conclusion: Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft can better restore the anterior knee stability compared with a conventional single-bundle reconstruction. Both reconstruction techniques are efficient in restoring the normal medial-lateral stability but overcorrect the internal tibial rotations.

Clinical relevance: Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft could provide improved clinical outcomes over a conventional single-bundle reconstruction.

Conflict of interest statement

The authors declared that they had no conflicts of interests in their authorship and publication of this contribution.

Figures

Figure 1
Figure 1
Single-bundle (A) and anatomical single-tunnel (B) ACL reconstructions. AMB, anteromedial bundle; PLB, pos-terolateral bundle.

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