Anatomic double-bundle anterior cruciate ligament reconstruction.
Several double-bundle anterior cruciate ligament (ACL) reconstruction procedures were reported in the 1980s and 1990s. However, no significant differences were found in the clinical results between these double-bundle procedures and single-bundle procedures because the double-bundle procedures appeared to reconstruct only the anteromedial bundle with 2 bundles. In the early 2000s, we proposed a new concept of anatomic reconstruction of the anteromedial and posterolateral bundles, in which 4 independent tunnels were created through the center of each anatomic attachment of the 2 bundles. We called it "anatomic" double-bundle ACL reconstruction. Biomechanical studies have shown that the anatomic double-bundle ACL reconstruction can restore knee stability significantly more closely to the normal level than the conventional single-bundle reconstruction. Recent intraoperative measurement studies have shown that the clinically available anatomic double-bundle procedures can reconstruct knee stability significantly better and improve knee function close to the normal level at the time immediately after surgery compared with the conventional single-bundle procedures. However, the greatest criticism of the anatomic double-bundle reconstruction is whether its clinical results are better than the results of single-bundle reconstruction. To date (January 2010), 10 prospective comparative clinical trials (Level I or II) and 1 meta-analysis have been reported comparing single-bundle and anatomic double-bundle reconstructions using hamstring tendons. In 8 of the 10 studies, the anterior and/or rotatory stability of the knee was significantly better with the anatomic double-bundle ACL reconstruction than with the conventional single-bundle reconstruction. However, 1 original trial and the meta-analysis found that there were no differences in the results between the 2 types of reconstructions. Thus the utility of the anatomic double-bundle reconstruction has not yet been established. Our review does show how much evidence exists as to the benefits of double-bundle ACL reconstruction at present.
Yasuda
Kazunori
K
Department of Sports Medicine & Joint Surgery, Hokkaido University School of Medicine, Kita-ku, Sapporo, Japan. yasukaz@med.hokudai.ac.jp
Tanabe
Yoshie
Y
Kondo
Eiji
E
Kitamura
Nobuto
N
Tohyama
Harukazu
H
D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy / Q000379:methods*; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D005269:Femur / Q000601:surgery; D006801:Humans; D015201:Meta-Analysis as Topic; D011446:Prospective Studies; D020127:Recovery of Function; D012399:Rotation; D053441:Suture Anchors; D013710:Tendons / Q000637:transplantation*; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome