From Reuters Health Information
NEW YORK (Reuters Health) Jun 08 - Although double-bundle and single-bundle anterior cruciate ligament (ACL) reconstruction provide similar anterior or rotational laxity of the knee, the double-bundle procedure results in significantly fewer revisions attributable to graft failure.
These findings from a prospective, randomized trial by Dr. Piia Suomalainen of Tampere University Hospital, Finland, and colleagues were published online on May 24 by the American Journal of Sports Medicine.
The ACL's anteromedial bundle is tensioned in all flexion angles of the knee, while the posterolateral bundle functions in low knee-flexion angles and is also tightened during external and internal rotation of the tibia.
The report notes that some earlier studies had shown that the double-bundle technique "restores knee kinematics and especially rotational stability of the knee" more closely than the single-bundle technique, though the knee's anterior stability can be restored well with single-bundle technique.
One hundred fifty-three patients underwent ACL reconstruction at a single center over a period of five years.
All ACL reconstructions were performed by a single experienced orthopedic surgeon, and all procedures involved 4-strand autografts made of doubled semitendinosus and doubled gracilis tendons and aperture interference screw fixation. Single-bundle surgeries were performed on the anteromedial bundle.
At the end of a minimum two-year follow-up, 121 patients remained. This group excluded 8 patients who had graft failure during follow-up and then underwent ACL revision surgery, as well as 9 patients who had ACL reconstruction of the contralateral knee during the follow-up period.
Seven of the eight patients who experienced graft failure had undergone the single-bundle procedure (P = 0.04).
The two examiners who performed the clinical assessments were blinded to the type of ACL reconstruction.
No significant differences were found between the two groups in terms of anterior stability or rotational stability of the knee. In both groups, knee stability at two years of follow-up was significantly better than it had been preoperatively.
However, the total number of failures and invisible grafts on MRI were significantly higher in the single bundle group (12 patients, 15%) than the double bundle group (3 patients, 4%; p=0.024).
The report noted that MRI findings didn't correlate with clinical evaluation of knee stability. The authors also say that "additional years of follow-up are needed to reveal the long-term results."
For further information:http://www.medscape.com/viewarticle/744217?src=mp&spon=8
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