title: Double-bundle reconstruction cannot restore intact knee kinematics in the ACL/LCL-deficient knee.
abstract: BACKGROUND
  The aim of this study was to evaluate the effect of single-bundle (SB) and anatomic double-bundle (DB) anterior cruciate ligament (ACL) reconstruction on the resulting knee kinematics in a simulated clinical setting with ACL rupture and associated extra-articular damage to the lateral structures. It was hypothesized that anatomic DB ACL reconstruction restores the intact knee kinematics in ACL/LCL-deficient knees, whereas SB ACL reconstruction fails to restore the intact knee kinematics.
  
  
  METHODS
  Ten fresh-frozen human cadaver knees were subjected to anterior tibial load of 134 N (simulated KT 1000) and combined rotatory load of 10-Nm valgus and 4-Nm internal tibial torque (simulated pivot shift) using a robotic/UFS testing system. The resulting knee kinematics was determined for intact, ACL/LCL-deficient, SB ACL-reconstructed/LCL-deficient, and DB ACL-reconstructed/LCL-deficient knee. Statistical analysis was performed using a two-way ANOVA test with the level of significance set at P < 0.05.
  
  
  RESULTS
  Under a simulated KT 1000 test, anterior tibial translation (ATT) following SB ACL reconstruction was statistically significant at 0 degrees , 30 degrees and 60 degrees of knee flexion when compared to the intact knee. ATT after DB ACL reconstruction showed no statistically significant difference from the intact knee; however, there was a significant difference in SB reconstruction at 0 degrees and 30 degrees of knee flexion. Under a simulated pivot shift test, both SB and DB ACL reconstruction failed to restore the intact knee kinematics.
  
  
  CONCLUSIONS
  The results of the study did not support our initial hypothesis. Though DB reconstructions were significantly superior to SB reconstruction under simulated KT 1000 test, SB as well as DB reconstruction failed to restore the intact kinematics under simulated pivot shift loads. The clinical relevance of this study is that caution and precise preoperative diagnostics are needed to avoid failure of intra-articular ACL reconstruction if the extra-articular stabilizers are torn.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Wilhelms University Muenster, Germany. thore.zantop@ukmuenster.de
authors.forename: Thore
authors.initials: T
authors.lastname: Zantop
authors.forename: Tobias
authors.initials: T
authors.lastname: Schumacher
authors.forename: Steffen
authors.initials: S
authors.lastname: Schanz
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Raschke
authors.forename: Wolf
authors.initials: W
authors.lastname: Petersen
mesh_terms: D000368:Aged; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D001696:Biomechanical Phenomena; D006801:Humans; D007718:Knee Injuries / Q000503:physiopathology* / Q000601:surgery; D007719:Knee Joint / Q000503:physiopathology*; D017888:Medial Collateral Ligament, Knee / Q000293:injuries; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012371:Robotics; D012421:Rupture; D017211:Treatment Failure