Double bundle anterior cruciate ligament reconstruction: Failure rate and patients-reported outcomes at 4-11 years of follow up

Piero Volpi; Alessandro Quaglia; Giulia Carimati; Marco Galli; Rocco Papalia; Stefano Petrillo

doi:10.1016/j.jor.2019.02.021

Double bundle anterior cruciate ligament reconstruction: Failure rate and patients-reported outcomes at 4-11 years of follow up

J Orthop. 2019 Feb 28;16(3):224-229. doi: 10.1016/j.jor.2019.02.021. eCollection 2019 May-Jun.

Authors

Piero Volpi¹, Alessandro Quaglia¹, Giulia Carimati¹, Marco Galli², Rocco Papalia³, Stefano Petrillo³

Affiliations

¹ Knee Surgery and Sports Traumatology Unit, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
² Centre of Sports Traumatology and Arthroscopic Surgery, Galeazzi Orthopaedics Institution of Milan, Via Riccardo Galeazzi 4, 20161, Milan, Italy.
³ Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro Del Portillo, 200, 00128, Trigoria, Rome, Italy.

Abstract

Background: Biomechanical studies have demonstrated that single bundle (SB) anterior cruciate ligament (ACL) reconstruction (SB-ACLr), which represents the gold standard for the management of ACL lesions, is not sufficient to completely restore the rotational stability and resistance to valgus stress of the knee.

Purpose: To evaluate the failure rate and patients reported outcomes at a long-term follow-up of double bundle anterior cruciate ligament reconstruction (DB-ACLr).

Study design: Retrospective cohort study.

Materials and methods: The database of arthroscopic DB-ACLr procedures performed from 2006 to 2015 at our Institution was retrospectively reviewed. Patients were screened for eligibility according to the following inclusion criteria: magnetic resonance imaging (MRI) evidence of anterior cruciate ligament (ACL) lesion, positive anterior drawer test and/or Lachman test; age ≤ 45 years at the time of surgery; DB-ACLr with autologous hamstrings, minimum follow up of 24 months. Patients were excluded if they presented associated lesions of the knee preoperatively or at the time of surgery, expect for meniscal lesions, or in case of inability to complete clinical questionnaires. Clinical outcomes were assessed at a mean follow up of 95.4 ± 21.9 months (range 51-129 months; median 98 months) using the Tegner-Lysholm score and the IKDC subjective score. Failures were defined as Tegner-Lysholm score ≤65 points, and were confirmed with MRI.

Results: 58 (81.7%) male and 13 (18.3%) female patients (mean age 29.7 ± 7.8 years) were included in the study. 2 (2.8%, 95% CI 0.3-9.8%) patients had a failure of DB-ACLr both occurred after a sports trauma. The IKDC subjective score was statically better in patients younger than 30 years. Tegner-Lysholm and IKDC subjective score were statistically better in professional athletes and in patients with isolated medial or lateral meniscus lesion instead of combined medial and lateral meniscus lesion.

Conclusion: DB-ACLr technique provides excellent clinical results at a long term follow-up. Low failure rate and high percentage of return to sports participation at the same pre-injury level was found in our cohort of patients.

Keywords: Anterior cruciate ligament; Arthroscopy; Clinical outcomes; Double bundle; Failure.