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Randomized Controlled Trial
, 98 (11), e14851

Single-tunnel Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Has the Same Effectiveness as Double Femoral, Double Tibial Tunnel: A Prospective Randomized Study

Affiliations
Randomized Controlled Trial

Single-tunnel Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Has the Same Effectiveness as Double Femoral, Double Tibial Tunnel: A Prospective Randomized Study

Xianxiang Xiang et al. Medicine (Baltimore).

Abstract

Purpose: To investigate whether single femoral, single tibial tunnel anatomic double-bundle anterior cruciate ligament (ACL) reconstruction is equal to or superior to double femoral, double tibial tunnel ACL double-bundle anatomic reconstruction in terms of restoring the stability and functions of the knee joint.

Methods: A prospective clinical study was performed to compare 30 cases of single-tunnel ACL double-bundle anatomic reconstruction to 28 cases of double-tunnel ACL double-bundle anatomic reconstruction, with average follow-up of 36 months. All graft tendons were hamstring tendon autografts. Tunnel placements in all the cases were made anatomically. Clinical results were collected after reconstruction. Graft appearance, meniscus status and cartilage state under arthroscopy were compared and analyzed.

Results: Tunnel placements were in the anatomic positions in both groups. On the lateral pivot-shift test performed at 36 months postoperatively, there was no significant difference between groups. Clinical results such as International Knee Documentation Committee score, Tegner activity scale, and range of motion showed no significant differences between the groups. The mean thickness of anteromedial graft was reduced by 10.3% and that of the posterolateral graft was reduced by 11.1% from the original graft thickness evaluated by magnetic resonance imaging. No new meniscal tears were found either group; however, cartilage damage occurred in the double-tunnel group at 39.3%, and this rate was significantly higher than that in the single-tunnel group (10.0%).

Conclusion: Single femoral, single tibial tunnel anatomic double-bundle ACL reconstruction has the same effectiveness as the double femoral, double tibial tunnel in restoring the knee's stability and functions.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
This is the model of the ACL footprint on femoral. ACL = anterior cruciate ligament.
Figure 2
Figure 2
This is the femoral tunnel, the intactness bonny wall.
Figure 3
Figure 3
The AM bundle and PL bundle are near parallel with the knee extended. AM = anteromedial, PL = posterolateral.
Figure 4
Figure 4
The AM bundle and PL bundle twist around each other as the knee flexes. AM = anteromedial, PL = posterolateral.
Figure 5
Figure 5
When the knee extended, no impingement occurred.
Figure 6
Figure 6
a: on oblique sagittal MRI, the 2 bundles were seen clearly, and near parallel with the knee extended (Healthy people);b: Under oblique sagittal MRI, the 2 bundles were seen clearly, and near parallel with the knee extended (postoperation). MRI = magnetic resonance imaging.
Figure 7
Figure 7
On oblique coronal MRI, the 2 bundles were seen clearly. a:postoperation; b: healthy people. MRI = magnetic resonance imaging.
Figure 8
Figure 8
a; the foofprint of tibial postoperation of ACL-R; b: ACL footprint of helthy people. ACL = anterior cruciate ligament.
Figure 9
Figure 9
a: the ACL shape on MRI in patients postoperation; b: the ACL shape on MRI in healthy people. ACL = anterior cruciate ligament, MRI = magnetic resonance imaging.
Figure 10
Figure 10
On oblique sagittal MRI. MRI = magnetic resonance imaging.
Figure 11
Figure 11
On oblique coronal MRI. MRI = magnetic resonance imaging.

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