Comparing stability of different single- and double-bundle anterior cruciate ligament reconstruction techniques: a cadaveric study using navigation.
OBJECTIVE
The objective of this study was to analyze 2 different single-bundle anterior cruciate ligament (ACL) reconstruction procedures and compare their ability to reduce the pivot-shift phenomenon with an anatomic double-bundle (DB) technique.


METHODS
Twelve fresh-frozen cadaveric hip-to-toe lower extremity specimens were used. ACL reconstructions were performed by conventional single-bundle, anteromedial (AM) single-bundle, and DB techniques. Anterior tibial translation was measured in the intact knee, ACL-deficient knee, and the 3 ACL reconstructions in response to a Lachman test and a mechanized pivot-shift test. A surgical navigation system (Praxim Medivision, Grenoble, France) simultaneously tracked kinematics.


RESULTS
Intact knees were clinically graded as grade 0 (n = 12). ACL-deficient knees were graded as grade 1 (n = 10) and grade 2 (n = 2). With a mechanized pivot-shift test, anterior tibial translation was 1.7 +/- 3.0 mm, 9.7 +/- 3.8 mm, 4.4 +/- 1.0 mm, 1.8 +/- 1.5 mm, and -1.7 +/- 3.3 mm for intact knees, ACL-deficient knees, conventional technique, AM technique, and DB technique, respectively. There was a significant difference between the DB technique and both single-bundle techniques tested (P < .05).


CONCLUSIONS
The model used represents an isolated ACL injury without concomitant injury to the capsuloligamentous restraints or menisci. However, during the pivot shift, neither type of single-bundle ACL reconstruction stabilized the knee to the same degree as the DB ACL reconstruction.


CONCLUSIONS
In this cadaveric model a DB repair offers great anterior and rotational stability. Although this study suggests that the DB technique is biomechanically superior to a single-bundle technique using traditional transtibial tunnel positions, there appear to be minimal differences in knee kinematics during stability testing with the DB technique versus an AM graft position. Indeed, compared with the AM position alone, the DB technique "overconstrained" the kinematics of the knee during a pivoting maneuver at time zero in a cadaveric model with an isolated ACL injury.
Musahl
Volker
V
Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York 10021, USA.
Voos
James E
JE
O'Loughlin
Padhraig F
PF
Choi
Daniel
D
Stueber
Volker
V
Kendoff
Daniel
D
Pearle
Andrew D
AD
D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001696:Biomechanical Phenomena; D002102:Cadaver; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007593:Joint Instability / Q000503:physiopathology; D007719:Knee Joint / Q000503:physiopathology; D009038:Motion; D019637:Orthopedic Procedures / Q000379:methods*; D010865:Pilot Projects; D013710:Tendons / Q000637:transplantation*; D013977:Tibia / Q000601:surgery