title: An in vitro biomechanical comparison of anterior cruciate ligament reconstruction: single bundle versus anatomical double bundle techniques.
abstract: BACKGROUND
  Anterior cruciate ligament ruptures are frequent, especially in sports. Surgical reconstruction with autologous grafts is widely employed in the international literature. Controversies remain with respect to technique variations as continuous research for improvement takes place. One of these variations is the anatomical double bundle technique, which is performed instead of the conventional single bundle technique. More recently, there has been a tendency towards positioning the two bundles through double bone tunnels in the femur and tibia (anatomical reconstruction).
  
  
  OBJECTIVE
  To compare, through biomechanical tests, the practice of anatomical double bundle anterior cruciate ligament reconstruction with a patellar graft to conventional single bundle reconstruction with the same amount of patellar graft in a paired experimental cadaver study.
  
  
  METHODS
  Nine pairs of male cadaver knees ranging in age from 44 to 63 years were randomized into two groups: group A (single bundle) and group B (anatomical reconstruction). Each knee was biomechanically tested under three conditions: intact anterior cruciate ligament, reconstructed anterior cruciate ligament, and injured anterior cruciate ligament. Maximum anterior dislocation, rigidity, and passive internal tibia rotation were recorded with knees submitted to a 100 N horizontal anterior dislocation force applied to the tibia with the knees at 30, 60 and 90 degrees of flexion.
  
  
  RESULTS
  There were no differences between the two techniques for any of the measurements by ANOVA tests.
  
  
  CONCLUSIONS
  The technique of anatomical double bundle reconstruction of the anterior cruciate ligament with bone-patellar tendon-bone graft has a similar biomechanical behavior with regard to anterior tibial dislocation, rigidity, and passive internal tibial rotation.
authors.affiliation: Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. sandraort@uol.com.br
authors.forename: Sandra Umeda
authors.initials: SU
authors.lastname: Sasaki
authors.forename: Roberto Freire da
authors.initials: RF
authors.lastname: Mota e Albuquerque
authors.forename: César Augusto Martins
authors.initials: CA
authors.lastname: Pereira
authors.forename: Guilherme Simões
authors.initials: GS
authors.lastname: Gouveia
authors.forename: Júlio César Rodrigues
authors.initials: JC
authors.lastname: Vilela
authors.forename: Fábio de Lima
authors.initials: Fde L
authors.lastname: Alcarás
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001696:Biomechanical Phenomena; D002102:Cadaver; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures; D013710:Tendons / Q000637:transplantation*