Outcomes and second-look arthroscopic evaluation after double-bundle anterior cruciate ligament reconstruction with use of a single tibial tunnel.
BACKGROUND
The correlation between graft appearance and clinical outcome after double-bundle anterior cruciate ligament (ACL) reconstruction is a major concern. In this study, the graft appearance was assessed with use of second-look arthroscopy and was correlated with the clinical outcome. Overall clinical outcomes after double-bundle ACL reconstruction with use of a single tibial tunnel were analyzed.


METHODS
Thirty-seven knees that underwent second-look arthroscopy after double-bundle ACL reconstruction and sixty-two knees that underwent double-bundle ACL reconstruction without subsequent second-look arthroscopy were included in this retrospective study. The ninety-nine patients enrolled were followed for thirty-five months (range, twenty-four to fifty-eight months), and the mean duration from ACL reconstruction to second-look arthroscopy was twenty-five months (range, twelve to thirty-six months). Graft thickness, apparent graft tension, and synovial coverage were graded during second-look arthroscopy. Correlations were sought between graft appearance and Lysholm knee scores, International Knee Documentation Committee (IKDC) grades, anterior laxity, and pivot-shift test results.


RESULTS
Postoperatively, ninety-four (94.9%) of the ninety-nine knees had an IKDC rating of B or higher, mean anterior laxity was 1.29 mm (range, 0 to 6 mm), and ninety-two knees (92.9%) had a negative pivot-shift result. With regard to graft thickness and tension, anteromedial bundles were graded as A in twenty-eight (75.7%) of the thirty-seven second-look knees and as B in nine knees (24.3%). Posterolateral bundles were graded as A in twenty-five knees (67.6%), B in six knees (16.2%), and C in six knees (16.2%). With regard to synovial coverage, anteromedial bundles were graded as C in only two knees (5.4%) and posterolateral bundles were graded as C in six knees (16.2%). No correlation was found between graft appearance and clinical outcome.


CONCLUSIONS
In the present study, we observed that clinical outcomes were as satisfactory with a single tibial tunnel as with two tibial tunnels. However, more tears and poorer synovial coverage were observed for posterolateral than for anteromedial bundles during second-look arthroscopy. No significant correlation was found between graft appearance and clinical outcome.
Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Republic of Korea.
Jin Hwan
JH
Ahn
Sang-Hee
SH
Choi
Joon Ho
JH
Wang
Jae Chul
JC
Yoo
Hyun Seok
HS
Yim
Moon Jong
MJ
Chang
D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy / Q000379:methods*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D024162:Second-Look Surgery / Q000379:methods*; D018709:Statistics, Nonparametric; D013709:Tendon Transfer / Q000379:methods*; D013977:Tibia / Q000601:surgery; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult