Comparison of Outcomes Between All-Inside SingleBundle and Double-Bundle Anterior Cruciate Ligament Reconstruction: A Retrospective Study

@#Introduction: ACL rupture is the most common type of knee injury. The All-inside ACL reconstruction procedure features some distinguished components including closed-socket tunnels with less bone expulsion, double suspensory fixation, and smaller incisions. We aimed to compare the outcomes between the All-inside Single-bundle and the Double-bundle ACL reconstruction techniques. Materials and methods: This study was a retrospective study which analysed the patient-reported and the clinical outcomes on patients who underwent ACL reconstruction between January and December 2020 at Dr Kariadi General Hospital Semarang, Indonesia. We compared the patientreported and the clinical outcomes at 6- and 12-month follow-ups between the All-inside Single-bundle and the Double-bundle groups. The patient-reported outcomes were determined using the IKDC and Tegner-Lysholm scores while the clinical outcomes included the measurement of Thigh Circumference, Single Hop test, Anterior Drawer test, Lachman test, Range of motion, and the patient’s level of return to sport. Results: A total of 24 subjects were divided into two groups, namely the All-inside Single-bundle and the Double-bundle groups, consisting of 12 subjects in each group. Most of the subjects were male in both groups, including 9 (75%) subjects in the All-inside Single-bundle group, and 11 (91.67%) subjects in the Double-bundle group. The mean age of the subjects were 25.75±7.57 years old in the Allinside Single-bundle group, and 24.5±6.87 years old in the Double-bundle group. In terms of the side of the knee that suffered the most injuries in both groups were the right knees. The result of the patient-reported outcomes using IKDC and Tegner-Lysholm scores showed no statistically significant differences in both groups at 6- and 12-month follow-ups (p=0.864; p=0.293 and p=0.589; p=0.233, respectively). The results of clinical assessments at 6- and 12-month follow-ups also showed no statistically significant differences in both groups. Conclusion: Our study showed no significant differences in the patient-reported and the clinical outcomes between the All-inside Single-bundle and the Double-bundle ACL reconstruction techniques at 6- and 12-month follow-ups.

Relation between Second-look Arthroscopic Findings and Clinical Results after Double Bundle Anterior Cruciate Ligament Reconstruction

PURPOSE: This study examined the relationship between the findings of a second-look arthroscopy and clinical results in double bundle anterior cruciate ligament (ACL) reconstruction using hamstring tendons fixed with a Ligament Plate(R). MATERIALS AND METHODS: Twenty eight cases of a double bundle ACL reconstruction using hamstring tendons were retrospectively reviewed. The follow-up period was more than 1 year and all cases were reviewed by second-look arthroscopy. The average follow-up period was 20.6 months (range: 12-34 months). In second-look arthroscopy, the anteromedial (AM) bundle and posterolateral (PL) bundle of the grafts were evaluated based on the tension, rupture and synovial coverage. Clinical evaluation was assessed using the Lysholm score, international knee documentation committee score, Hop test, Lachman test, pivot shift test, KT-2000 arthrometer and anterior drawer stress radiograph using Telos(R) in 30degrees knee flexion. The correlation between the arthroscopic findings of the grafts and the instability tests was evaluated. RESULTS: The AM graft was evaluated as being taut in 89.3% and lax in 10.7%, and the PL graft was assessed as being taut in 71.4% and lax in 28.6% according to the tension. The AM and PL grafts were evaluated as 'no rupture' in 78.6% and 'partial rupture' in 21.4%. There was no 'complete rupture' in any graft. The AM grafts were found to be good in 53.6%, fair in 35.7% and poor in 10.7%; the PL grafts were assessed as good in 50.0%, fair in 28.6% and poor in 21.4% according to the synovial coverage. The AM graft tension showed statistically significant results regarding both the Lachman test (rho=0.743, p<0.001) and degree of rupture (rho=0.438, p=0.020). The PL graft tension showed statistically significant results regarding both the pivot shift test (rho=0.548, p=0.003) and the degree of rupture (rho=0.663, p<0.001). CONCLUSION: Double bundle ACL reconstructions using hamstring tendons show good biological and clinical results. The graft tension and the degree of rupture show a statistically significant relationship to the stability of the reconstructed joint. On the other hand, the synovial coverage did not show a significant result.

The Relationship between the Evaluation of the Graft-bone Interface and the Clinical Results after Double Bundle Anterior Cruciate Ligament Reconstruction

PURPOSE: This study examined the relationship between an evaluation of the graft-bone interface using magnetic resonance (MR) arthrography and the clinical results after double bundle anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS: From December 2005 to October 2007, 15 cases that underwent double bundle ACL reconstruction and that were evaluated by MR arthrography were reviewed. The mean follow-up period was 20 months. The graft-bone interface was assessed by the leakage of contrast medium seen on MR arthrography. Four groups were classified according to the degree of contrast media leakage: no contrast media leakage, the focal type, the crescent type and the circumferential type. A functional evaluation was made using the Lysholm score, the international knee documentation committee (IKDC) score, the difference in the midthigh circumference and the Hop test. The stability was evaluated using a Lachmann test, a pivot shift test, a KT-2000 arthrometer and an anterior drawer stress radiograph using Telos(R) with the knee in 30degrees flexion. RESULTS: Ten cases showed no leakage of contrast media, five cases showed focal leakage and there was no case of crescent and circumferential leakage. The clinical results of the no leakage and focal leakage groups were compared. The functional evaluation such as the Lysholm score, the IKDC score, the difference in the midthigh circumference and the Hop test showed no significant difference between the two groups. The stability evaluation, such as the Lachmann test, the pivot shift test, the KT-2000 arthrometer and anterior drawer stress radiograph, also showed no significant difference. CONCLUSION: On MR arthrography after double bundle ACL reconstruction, adequate osteointegration and satisfactory clinical results could be obtained in the no leakage and focal leakage groups.

Short-term Follow-up of Double Bundle ACL Reconstruction using Autogenous Hamstring Tendons Fixed with Ligament Plate(R) / 대한정형외과학회잡지

PURPOSE: We wanted to evaluate the clinical outcomes at a minimum 1-year following anatomic double bundle ACL reconstruction with using autogenous hamstring tendons fixed with Ligament Plate(R). MATERIALS AND METHODS: We evaluated a total of 50 patients. Semitendinosus tendon was used for the reconstruction of the anteromedial bundle and the gracilis tendon was used for the reconstruction of the posterolateral bundle. For femoral fixation, we used an anteromedial bundle that was suspended in Ligament Plate(R) and a posterolateral bundle linked with Mersilene tape(R). For tibial fixation, we used double post-tie. The average follow-up period was 16.5 months. We analyzed the clinical and radiographic results. RESULTS: At the last follow-up, the Lysholm score was 92.4+/-6.8 points. For the IKDC score, there were 35 cases of grade A, 14 cases of grade B and 1 case of grade C. The Lachman test was negative for 40 cases, it was grade 1 for 9 cases and it was grade 2 for 1 case and the pivot shift test was negative for 45 cases and it was grade 1 for 5 cases. The side-to-side differences with the KT-2000 and the anterior drawer radiogram were 1.3+/-1.6 mm and 1.3+/-1.3 mm, respectively. The femoral tunnel enlarged to 1.7+/-0.6 mm in the anteromedial aspect and 1.6+/-0.7 mm in the posterolateral aspect, and the tibial tunnel enlarged to 1.2+/-0.4 mm in the anteromedial aspect and 1.4+/-0.5 mm in the posterolateral aspect. CONCLUSION: Anatomic ACL reconstruction using autogenous hamstring tendons that are fixed with Ligament Plate(R) showed good clinical results due to the strong strength of early fixation and the anatomic restoration of the ACL.