Purpose
The purpose of this study was to evaluate the short-term clinical results and location
of the bone tunnel with a new surgical procedure for all-inside double-bundle anterior
cruciate ligament (ACL) reconstruction.
Methods
The double-bundle ACL reconstruction procedure was performed in 24 patients (13 male
and 11 female patients) with a mean age of 31.0 years. Anterior and posterior tibial
translation using an arthrometer (KT-1000; MEDmetric, San Diego, CA) and the Lysholm
score were measured before surgery and at a mean of 24.8 months (range, 13 to 45 months)
postoperatively. Computed tomography scans were taken to evaluate the bone tunnel
positions using 3-dimensional images with the quadrant method for the femoral tunnel
and Stäubli's technique for the tibial tunnel.
Results
Three-dimensional computed tomography scans showed that the anteromedial and posterolateral
tunnels were placed in anatomically appropriate positions. Arthrometric measurements
showed that the mean side-to-side differences were 5.3 mm (SD, 1.6 mm) preoperatively
and 0.05 mm (SD, 0.7 mm) at a mean of 24.8 months postoperatively, indicating a remarkable
improvement (P < .00001). The mean Lysholm score was 56.3 points (SD, 14.8 points) preoperatively
and 95.5 points (SD, 3.8 points) at final follow-up and was significantly improved
after the operation (P < .00001).
Conclusions
The all-inside double-bundle ACL reconstruction technique used in this study resulted
in the creation of tunnels in an anatomically appropriate position. Short-term clinical
follow-up showed improvement in patient-reported outcomes and knee stability. This
technique may provide an alternative option for all-inside ACL reconstruction.
Level of Evidence
Level IV, therapeutic case series.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Endoscopic versus rear-entry ACL reconstruction: A systematic review.Clin Orthop Relat Res. 2007; 455: 158-161
- “Anatomic” anterior cruciate ligament reconstruction: A systematic review of surgical techniques and reporting of surgical data.Arthroscopy. 2010; 26 (suppl): S2-S12
- Comparative kinematic evaluation of all-inside single-bundle and double-bundle anterior cruciate ligament reconstruction: A biomechanical study.Am J Sports Med. 2010; 38: 263-272
- The 1:1 versus the 2:2 tunnel-drilling technique: Optimization of fixation strength and stiffness in an all-inside double-bundle anterior cruciate ligament reconstruction—A biomechanical study.Am J Sports Med. 2009; 37: 1539-1547
- Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction.Am J Sports Med. 2002; 30: 660-666
- Tunnel expansion after anterior cruciate ligament reconstruction with autogenous hamstrings: A comparison of the medial portal and transtibial techniques.Arthroscopy. 2006; 10: 1107-1112
- Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used: A prospective randomized study.Arthroscopy. 2005; 21: 1337-1341
- Bone tunnel widening after anterior cruciate ligament reconstruction using EndoButton or EndoButton continuous loop.Arthroscopy. 2009; 25: 1275-1280
- Comparison of plain radiography, computed tomography, and magnetic resonance imaging in the evaluation of bone tunnel widening after anterior cruciate ligament reconstruction.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 1059-1064
- Bone tunnel enlargement after anterior cruciate ligament reconstruction with semitendinosus tendon using Endobutton fixation on the femoral side.Arthroscopy. 1998; 14: 810-815
- Observations on bone tunnel enlargement after double-bundle anterior cruciate ligament reconstruction.Arthroscopy. 2007; 23: 291-298
- Bone tunnel enlargement after anterior cruciate ligament reconstruction: Fact or fiction?.Knee Surg Sports Traumatol Arthrosc. 1998; 6: 231-240
- Outcome of revision anterior cruciate ligament reconstruction: A systemic review.J Bone Joint Surg Am. 2012; 94: 531-536
- The all-inside ACL reconstruction.in: Morgan C.D. Operative technique manual. Arthrex, Naples, FL1995
- ACL reconstruction with “the original all-inside technique.”.Knee Surg Sports Traumatol Arthrosc. 2011; 19: 829-831
- No-tunnel anterior cruciate reconstruction: The transtibial all-inside technique.Arthroscopy. 2006; 22: 900.e1-900.e11
- My technique in femoral tunnel preparation: The “Retro-Drill” technique.Tech Orthop. 2005; 20: 224-227
- All-inside patellar tendon anterior cruciate ligament reconstruction.Sports Med Arthrosc. 2009; 17: 252-258
- All-inside anterior cruciate ligament reconstruction using semitendinosus tendon and soft threaded biodegradable interference screw fixation.Arthroscopy. 1997; 13: 773-779
- All-inside ACL: Retroconstruction controversies.Sports Med Arthrosc. 2010; 18: 20-26
- Randomized controlled trial comparing all-inside anterior cruciate ligament reconstruction technique with anterior cruciate ligament reconstruction with a full tibial tunnel.Arthroscopy. 2013; 29: 1195-1200
- Laser-guided placement of the tibial guide in the transtibial technique for anterior cruciate ligament reconstruction.Arthroscopy. 2009; 25: 212-214
- Femoral insertion of the ACL: Radiographic quadrant method.Am J Knee Surg. 1997; 10: 14-21
- Anterior cruciate ligament graft positioning, tensioning, and twisting.Knee Surg Sports Traumatol Arthrosc. 1998; 6 (suppl 1): S2-S12
- Tunnel positioning of anteromedial and posterolateral bundles in anatomic cruciate ligament reconstruction. Anatomic and radiographic findings.Am J Sports Med. 2008; 36: 65-72
- Morphology of anterior cruciate ligament attachments for anatomic reconstruction: A cadaveric dissection and radiographic study.Arthroscopy. 2006; 22: 984-992
- The location of femoral and tibial tunnels in anatomic double-bundle anterior cruciate ligament reconstruction analyzed by three-dimensional computed tomography models.J Bone Joint Surg Am. 2010; 92: 1418-1426
- Tunnel position and relationship to postoperative knee laxity after double-bundle anterior cruciate ligament reconstruction with a transtibial technique.Am J Sports Med. 2010; 38: 698-706
- Development and application of an inside-to-out drill bit for anterior cruciate ligament reconstruction.Arthroscopy. 2005; 21: 1012
- Anatomic tibial graft fixation using a retrograde bio-interference screw for endoscopic anterior cruciate ligament reconstruction.Arthroscopy. 2002; 18: E38
- Tibial aperture bone disruption after retrograde versus antegrade tibial tunnel drilling: A cadaveric study.Knee Surg Sports Traumatol Arthrosc. 2008; 16: 818-822
- No tunnel 2-socket technique: All-inside anterior cruciate ligament double-bundle retroconstruction.Arthroscopy. 2008; 24: 1184-1189
- Double bundle “anatomic” anterior cruciate ligament reconstruction: A cadaveric study of tunnel positioning with a transtibial technique.Arthroscopy. 2007; 23: 7-13
- Impact of tibial and femoral tunnel position on clinical results after anterior cruciate ligament reconstruction.Arthroscopy. 2011; 27: 355-364
- Comparison of anterior cruciate ligament position and graft obliquity with transtibial and anteromedial portal femoral tunnel reaming techniques using high-resolution magnetic resonance imaging.Arthroscopy. 2011; 27: 1511-1522
- The relationship between femoral tunnels created by the transtibial, anteromedial portal, and outside-in techniques and the anterior cruciate ligament footprint.Am J Sports Med. 2012; 40: 882-888
- Anatomical limitations of transtibial drilling in anterior cruciate ligament reconstruction.Am J Sports Med. 2007; 35: 1708-1715
- Comparison of 4 femoral tunnel drilling techniques in anterior cruciate ligament reconstruction.Arthroscopy. 2012; 28: 972-979
- Coverage of the anterior cruciate ligament femoral footprint using 3 different approaches in single-bundle reconstruction. A cadaveric study analyzed by 3-dimensional computed tomography.Am J Sports Med. 2013; 41: 2375-2383
- ACL reconstruction: Comparison between transtibial and anteromedial portal techniques.Knee Surg Sports Traumatol Arthrosc. 2012; 20: 896-903
- Comparison of tunnel orientation between transtibial and anteromedial portal techniques for anatomic double-bundle anterior cruciate ligament reconstruction using 3-dimensional computed tomography.Arthroscopy. 2013; 29: 195-204
- Anatomic femoral tunnel drilling in anterior cruciate ligament reconstruction: Use of an accessory medial portal versus traditional transtibial drilling.Am J Sports Med. 2012; 40: 1313-1321
- The attachments of the anteromedial and posterolateral fibre bundles of the anterior cruciate ligament. Part 1: Tibial attachment.Knee Surg Sports Traumatol Arthrosc. 2007; 15: 1414-1421
- Evaluation of tunnel placement in the anatomical double-bundle ACL reconstruction. A cadaver study.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 1226-1231
- Comparison of tunnel locations of double bundle ACL reconstruction using the conventional transtibial technique with anatomic tunnel locations using a 3D CT model.Arch Orthop Trauma Surg. 2013; 133: 1121-1128
Article info
Publication history
Published online: May 13, 2015
Accepted:
March 18,
2015
Received:
June 27,
2014
Footnotes
The authors report the following potential conflict of interest or source of funding: S.W. and T.T. receive support from Japanese Foundation for Research and Promotion of Endoscopy. Grant in 2012.
Identification
Copyright
© 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
