title: Comparison of rotatory stability after anterior cruciate ligament reconstruction between single-bundle and double-bundle techniques.
abstract: BACKGROUND
  Controversy persists as to whether double-bundle reconstruction of the anterior cruciate ligament (ACL) has any clinical advantage over single-bundle reconstruction. Several studies have used subjective and nonquantitative manual tests to evaluate the rotatory stability of the knee. The authors have developed a method to quantitate the rotatory stability of the ACL-deficient knee using open magnetic resonance imaging (MRI).
  
  
  OBJECTIVE
  Anatomic double-bundle reconstruction restores rotatory stability significantly better than does single-bundle reconstruction.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  Twenty-three consecutive patients treated with the single-bundle reconstruction (group S) and 25 consecutive patients treated with the anatomic double-bundle reconstruction (group D) were evaluated. Both reconstruction procedures were performed using hamstring tendon autografts. The Slocum anterolateral rotatory instability (ALRI) test was performed 1 year after surgery using open MRI. To assess rotatory stability, we measured the difference in anterior tibial translation between medial and lateral compartments in the sagittal plane and defined this difference as the ALRI value. In addition, clinical examinations consisting of the Lysholm knee score, Tegner activity score, KT-2000 arthrometer anterior translation examination, and the pivot-shift test were carried out.
  
  
  RESULTS
  The mean side-to-side difference in ALRI values was significantly less (P < .001) in double-bundle reconstruction (mean, 1.2 mm) than in single-bundle reconstruction (mean, 4.1 mm). The mean side-to-side difference in KT-2000 arthrometer measurements was significantly less (P = .014) in double-bundle reconstruction (mean, 1.2 mm) than in single-bundle reconstruction (mean, 2.6 mm). The difference in the incidence of positive pivot-shift tests between group S (43%) and group D (16%) did not reach the level of statistical significance (P = .058). No significant differences in Lysholm score or Tegner score between the groups were observed.
  
  
  CONCLUSIONS
  The rotatory stability of anatomic double-bundle reconstruction was significantly better than the rotatory stability of single-bundle reconstruction.
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Izawa
authors.forename: Ken
authors.initials: K
authors.lastname: Okazaki
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Tashiro
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Matsubara
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Miura
authors.forename: Shuichi
authors.initials: S
authors.lastname: Matsuda
authors.forename: Makoto
authors.initials: M
authors.lastname: Hashizume
authors.forename: Yukihide
authors.initials: Y
authors.lastname: Iwamoto
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D053587:Arthrometry, Articular; D001178:Arthroplasty / Q000379:methods*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis* / Q000503:physiopathology; D007718:Knee Injuries / Q000503:physiopathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D012399:Rotation; D055815:Young Adult