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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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.
