Purpose
The purposes of this study were to investigate anterior tibial translation under loading
conditions after single-bundle (SB) anterior cruciate ligament (ACL) reconstruction
using a rectangular tunnel placement strategy with quadriceps and bone–patellar tendon–bone
(BPTB) graft and to compare these data with a SB hamstring reconstruction with a round
tunnel design.
Methods
In 9 human cadaveric knees, the knee kinematics were examined with robotic/universal
force-moment sensor testing. Within the same specimen, the knee kinematics under simulated
pivot-shift and KT-1000 arthrometer (MEDmetric, San Diego, CA) testing were determined
at 0°, 15°, 30°, 60°, and 90° of flexion under different conditions: intact knee,
ACL-deficient knee, and SB ACL-reconstructed knee. For the SB ACL-reconstructed knee,
3 different SB reconstruction techniques were used: a rectangular tunnel strategy
(9 × 5 mm) with quadriceps graft, a rectangular tunnel strategy with BPTB graft, and
a round tunnel strategy (7 mm) with hamstring graft.
Results
In a simulated Lachman test, a statistically significant difference was found at 0°
and 15° of knee flexion between the rectangular reconstruction with quadriceps graft
(5.1 ± 1.2 mm and 8.3 ± 2 mm, respectively) or BPTB graft (5.3 ± 1.5 mm and 8 ± 1.9
mm, respectively) and the reconstruction using hamstring graft (7.2 ± 1.4 mm and 12
± 1.8 mm, respectively) (P = .032 and P = .033, respectively, at 0°; P = .023 and P = .02, respectively, at 15°). On the simulated pivot-shift test at 0° and 15°, rectangular
ACL reconstruction with quadriceps graft (3.9 ± 2.1 mm and 6.5 ± 1.7 mm, respectively)
or BPTB graft (4.2 ± 1.8 mm and 6.7 ± 1.7 mm, respectively) showed a significantly
lower anterior tibial translation when compared with round tunnel reconstruction (5.5
± 2.1 mm and 7.9 ± 1.9 mm, respectively) (P = .03 and P = .041, respectively, at 0°; P = .042 and P = .046, respectively, at 15°).
Conclusions
Under simulated Lachman testing and pivot-shift testing, a reconstruction technique
using a rectangular tunnel results in significantly lower anterior tibial translation
at 0° and 15° of flexion in comparison to knees reconstructed with a hamstring SB
graft using a round tunnel strategy.
Clinical Relevance
ACL reconstruction with a rectangular tunnel and BPTB and quadriceps tendon might
result in better anterior knee stability at low flexion angles than ACL reconstruction
with hamstring SB graft and a round tunnel in the clinical setting.
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References
- ACL mismatch reconstructions: Influence of different tunnel placement strategies in single-bundle ACL reconstructions on the knee kinematics.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 1551-1558
- Avoiding pitfalls in anatomic ACL reconstruction.Knee Surg Sports Traumatol Arthrosc. 2009; 17: 956-963
- Equal kinematics between central anatomic single-bundle and double-bundle anterior cruciate ligament reconstructions.Arthroscopy. 2009; 25: 464-472
- Does the position of the femoral tunnel affect the laxity or clinical outcome of the anterior cruciate ligament-reconstructed knee? A clinical, prospective, randomized, double-blind study.Arthroscopy. 2007; 23: 1326-1333
- The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis.Clin Orthop Relat Res. 1975; : 216-231
- Functional anatomy of the anterior cruciate ligament. Fibre bundle actions related to ligament replacements and injuries.J Bone Joint Surg Br. 1991; 73: 260-267
- Anatomy of the anterior cruciate ligament.Clin Orthop Relat Res. 1983; : 19-25
- Description of the attachment geometry of the anteromedial and posterolateral bundles of the ACL from arthroscopic perspective for anatomical tunnel placement.Knee Surg Sports Traumatol Arthrosc. 2007; 15: 1422-1431
- Graft laceration and pullout strength of soft-tissue anterior cruciate ligament reconstruction: In vitro study comparing titanium, poly-d, l-lactide, and poly-d, l-lactide-tricalcium phosphate screws.Arthroscopy. 2006; 22: 1204-1210
- Functional anatomy of the anterior cruciate ligament and a rationale for reconstruction.J Bone Joint Surg Am. 1985; 67: 257-262
- Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction: Anatomic and radiographic findings.Am J Sports Med. 2008; 36: 65-72
- Technique of anatomical footprint reconstruction of the ACL with oval tunnels and medial portal aimers.Arch Orthop Trauma Surg. 2013; 133: 827-833
- Anterior cruciate ligament anatomy and function relating to anatomical reconstruction.Knee Surg Sports Traumatol Arthrosc. 2006; 14: 982-992
- 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: A controlled, prospective trial.Am J Sports Med. 2007; 35: 564-574
- A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen.Arthroscopy. 2007; 23: 1320-1325.e6
- The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligament-deficient knee.Am J Sports Med. 2010; 38: 1591-1597
- A comparison of the effect of central anatomical single-bundle anterior cruciate ligament reconstruction and double-bundle anterior cruciate ligament reconstruction on pivot-shift kinematics.Am J Sports Med. 2010; 38: 1788-1794
- Implant-free anterior cruciate ligament reconstruction with the patella ligament and press-fit double bundle technique.Unfallchirurg. 2010; 113 (in German): 540-548
- The effectiveness of reconstruction of the anterior cruciate ligament with hamstrings and patellar tendon. A cadaveric study comparing anterior tibial and rotational loads.J Bone Joint Surg Am. 2002; 84: 907-914
- Biomechanical evaluation of two techniques for double-bundle anterior cruciate ligament reconstruction: One tibial tunnel versus two tibial tunnels.Am J Sports Med. 2007; 35: 228-234
- The role of the anteromedial and posterolateral bundles of the anterior cruciate ligament in anterior tibial translation and internal rotation.Am J Sports Med. 2007; 35: 223-227
- Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction.Am J Sports Med. 2002; 30: 660-666
- Initial fixation strength of two bioabsorbable pins for the fixation of hamstring grafts compared to interference screw fixation: Single cycle and cyclic loading.Am J Sports Med. 2004; 32: 641-649
- In-situ forces in the human posterior cruciate ligament in response to posterior tibial loading.Ann Biomed Eng. 1996; 24: 193-197
- Forces and moments in six-DOF at the human knee joint: Mathematical description for control.J Biomech. 1996; 29: 1577-1585
- A combined robotic/universal force sensor approach to determine in situ forces of knee ligaments.J Biomech. 1996; 29: 1357-1360
- Biomechanics of knee ligaments.Am J Sports Med. 1999; 27: 533-543
- Use of robotic technology for diathrodial joint research.J Sci Med Sport. 1999; 2: 283-297
- Evaluation of knee stability with use of a robotic system.J Bone Joint Surg Am. 2009; 91: 78-84
- Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o'clock and 10 o'clock femoral tunnel placement. 2002 Richard O'Connor Award paper.Arthroscopy. 2003; 19: 297-304
- Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads.J Orthop Res. 2004; 22: 85-89
- The effect of axial tibial torque on the function of the anterior cruciate ligament: A biomechanical study of a simulated pivot shift test.Arthroscopy. 2002; 18: 394-398
- Treatment of anterior cruciate ligament injuries, part I.Am J Sports Med. 2005; 33: 1579-1602
- The “footprint” anterior cruciate ligament technique: An anatomic approach to anterior cruciate ligament reconstruction.Arthroscopy. 2009; 25: 1128-1138
- Transtibial versus anteromedial portal reaming in anterior cruciate ligament reconstruction: An anatomic and biomechanical evaluation of surgical technique.Arthroscopy. 2011; 27: 380-390
- Femoral bone tunnel placement using the transtibial tunnel or the anteromedial portal in ACL reconstruction: A radiographic evaluation.Knee Surg Sports Traumatol Arthrosc. 2009; 17: 220-227
- Anterior cruciate ligament insertions on the tibia and femur and their relationships to critical bony landmarks using high-resolution volume-rendering computed tomography.Am J Sports Med. 2008; 36: 2083-2090
- Effect of tunnel position for anatomic single-bundle ACL reconstruction on knee biomechanics in a porcine model.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 2-10
- Anatomic double-bundle anterior cruciate ligament reconstruction.Arthroscopy. 2006; 22: 1000-1006
- Anatomic double bundle ACL reconstruction: A literature review.Knee Surg Sports Traumatol Arthrosc. 2007; 15 (discussion 965): 946-964
- Anatomic double-bundle anterior cruciate ligament reconstruction with hamstrings.Arthroscopy. 2003; 19: 540-546
- Anatomy of the anterior cruciate ligament with regard to its two bundles.Clin Orthop Relat Res. 2007; 454: 35-47
- Anatomically oriented anterior cruciate ligament reconstruction with a bone-patellar tendon-bone graft via rectangular socket and tunnel: A snug-fit and impingement-free grafting technique.Arthroscopy. 2005; 21: 1402
- Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts.Arthroscopy. 2004; 20: 1015-1025
- Prospective randomized comparison of double-bundle versus single-bundle anterior cruciate ligament reconstruction.Arthroscopy. 2008; 24: 137-145
- Single-and double-incision double-bundle ACL reconstruction.Clin Orthop Relat Res. 2007; 454: 108-113
- Prospective clinical comparisons of anatomic double-bundle versus single-bundle anterior cruciate ligament reconstruction procedures in 328 consecutive patients.Am J Sports Med. 2008; 36: 1675-1687
- Graft tension during active knee extension exercise in anatomic double-bundle anterior cruciate ligament reconstruction.Arthroscopy. 2010; 26: 214-222
- Positive pivot shift after ACL reconstruction predicts later osteoarthrosis: 63 patients followed 5-9 years after surgery.Acta Orthop Scand. 2004; 75: 594-599
- Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction.Am J Sports Med. 2004; 32: 629-634
- Anterior cruciate ligament reconstruction using 4-strand hamstring autograft: Conventional single-bundle technique versus oval-footprint technique.Arthroscopy. 2011; 27: 1502-1510
Article Info
Publication History
Published online: October 21, 2013
Accepted:
August 26,
2013
Received:
April 12,
2012
Footnotes
The authors report the following potential conflict of interest or source of funding: AGA (German Speaking Association of Arthroscopy and Joint Surgery). Research fund. M.H. receives support from Karl Storz ; T.Z. receives support from Karl Storz, AGA research grant , BMBF grant , and Ormed/DJO ; W.P. receives support from Clinical Excellence Circle , Otto Bock , Karl Storz, AGA research grant, BMBF grant, and Ormed/DJO.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
