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Double-Bundle Anterior Cruciate Ligament Reconstruction

A Computer-Assisted Orthopaedic Surgery Study

From the Orthopaedic Unit and Kirk Kilgour Sports Injury Center, Sant’Andrea Hospital, University of Rome "La Sapienza," Rome, Italy

^* Address correspondence to Andrea Ferretti, MD, Via Lidia 73, Rome, Italy 00179 (e-mail: aferretti51{at}virgilio.it).

Background: The biomechanical function of single-bundle anterior cruciate ligament reconstruction, in cadaveric studies, is successful in limiting anterior tibial translation in response to an anterior tibial load but seems to be insufficient to control a combined rotator load of internal and valgus torque. Anatomical double-bundle anterior cruciate ligament reconstruction might produce a better biomechanical outcome.

Hypothesis: The addition of the posterolateral bundle to the anteromedial bundle, in an in vivo double-bundle computer-assisted anterior cruciate ligament reconstruction, is able to reduce internal rotation of the tibia at 30° of knee flexion, compared with a standard single-bundle reconstruction.

Study Design: Controlled laboratory study.

Methods: Twenty consecutive anterior cruciate ligament reconstructions were performed in male patients in April and May 2006 with double-bundle gracilis and semitendinosus tendon grafts using the 2.0 OrthoPilot navigation system. Group A (10 patients) underwent standard single-bundle anterior cruciate ligament reconstruction with doubled gracilis and semitendinosus tendon graft; group B (10 patients) underwent double-bundle reconstruction with doubled gracilis and semitendinosus tendon graft. Anteroposterior displacement and internal and external rotation at 30° of knee flexion were evaluated before and after reconstruction, using manual maximum force.

Results: Both techniques significantly reduced anteroposterior displacement and internal and external rotation of the tibia with respect to preoperative anterior cruciate ligament–deficient condition (P < .05). Comparing groups, no differences in anteroposterior tibial displacement and internal and external rotation of the tibia were found (anteroposterior, 3.7 mm and 5.2 mm; internal rotation, 16.3° and 16.6°; external rotation, 15.7° and 15.1°, respectively) in group A and B (P = .06, .90, and .72, respectively).

Conclusion: The hypothesis that addition of the posterolateral bundle to the anteromedial bundle is able to reduce internal rotation of the tibia at 30° of knee flexion is not confirmed.

Clinical Relevance: The effective role of the anatomical double-bundle procedure in better restoring knee kinematics should be questioned in an in vivo model.

Key Words: double bundle • anterior cruciate ligament (ACL) reconstruction • computer-assisted orthopaedic surgery (CAOS) • kinematics