Biomechanics of single-tunnel double-bundle anterior cruciate ligament reconstruction using fixation with a unique expandable interference screw

Abstract

BackgroundSingle-tunnel double-bundle (STDB) anterior cruciate ligament (ACL) reconstruction can restore biomechanical function and anatomic structure, but existing methods of graft fixation are not adequate. The aims of this study are to examine knee biomechanics after STDB reconstruction using a unique expandable interference screw for fixation. MethodsThe biomechanical parameters of six pairs of human cadaveric knee specimens were measured with the ACL intact, after ACL removal, and after STDB reconstruction using the interference screw or single-tunnel single-bundle (STSB) reconstruction. Anterior tibial translation under 134N anterior tibial load in a neutral position as well as in 15° and 30° internal and external knee rotation and the internal tibial rotation angle under the rotatory load (5N·m internal tibial rotation) were measured. ResultsAnterior tibial translations at each degree of knee flexion in the STDB group were significantly less than in the STSB group (all, P<0.05). The internal rotation angles in the STSB group at five flexion angles were significantly higher than in the ACL intact group, whereas there were significantly less than those of the ACL absent group (P<0.05). Under rotatory loads in the neutral position, the tibial internal rotation angles of the STDB group were significantly lower than in the STSB group at all flexion angles (all, P<0.05). ConclusionsSTDB ACL reconstruction with the expandable interference screw provides better anteroposterior and rotational stability than STSB reconstruction. Clinical relevanceThe technique provides the advantages of double-bundle reconstruction using a single-tunnel technique.