Purpose
To evaluate the effect of posterolateral bundle (PLB) graft fixation angles on graft
tension curves and load sharing between the anteromedial bundle (AMB) and the PLB
in double-bundle anterior cruciate ligament (ACL) reconstruction.
Methods
Twenty-four patients who underwent double-bundle ACL reconstruction were included
in this study. AMB and PLB were provisionally fixed to a graft tensioning system during
surgery. The graft fixation settings were as follows: (1) AMB at 20° and PLB at 0°
(A20P0), (2) AMB at 20° and PLB at 20° (A20P20), and (3) AMB at 20° and PLB at 45°
(A20P45). Bundle tension was recorded during knee flexion-extension and in response
to anterior or rotatory loads. A pivot-shift test, as well as factors affecting the
residual pivot-shift, was also evaluated.
Results
A20P45 created reciprocal tension curves and load sharing, in which the tension in
both bundles was equivalent during flexion-extension and during each loading test
at 30°. In A20P0, the tension of the AMB was constantly higher than that of the PLB.
Seven patients showed grade 1 pivot-shift phenomenon in A20P0, whereas no patient
showed a positive pivot-shift at other settings. Larger tension reduction of the PLB
between 0° and 30° and smaller load sharing of the PLB were significant factors affecting
residual pivot-shift.
Conclusions
In double-bundle ACL reconstruction, fixation of the AMB at 20° and the PLB at 45°
created reciprocal tension curves and load sharing between the bundles. Fixation of
the AMB at 20° and the PLB at 0° led to insufficient tension in the PLB, resulting
in a residual pivot-shift phenomenon in 7 of 24 patients.
Level of Evidence
Level IV, therapeutic case series.
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Article info
Publication history
Published online: January 22, 2013
Accepted:
October 16,
2012
Received:
January 29,
2012
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
