Comparison of tunnel placements and clinical results of single-bundle anterior cruciate ligament reconstruction before and after starting the use of double-bundle technique

Abstract

To investigate whether the locations of the grafts in single-bundle (SB) anterior cruciate ligament (ACL) reconstruction have changed to more anatomical as the double-bundle (DB) method has become more familiar. Operation using anteromedial (not transtibial) portal and freehand technique [Group A (N=25) in 2003, Group B (N=25) in 2007]. The evaluation methods preoperatively and at the 2-year follow-up (two blinded examiners): clinical examination, stability measurement (KT-1000 arthrometer), the International Knee Documentation Committee (IKDC), and the Lysholm knee scores. A musculoskeletal radiologist made tunnel measurements from the magnetic resonance imaging (MRI). The average tunnel placement in the femoral side: from Blumensaat's line 27% (Group A) and 26% (Group B), from the posterior edge of the femur 32% (Group A) and 29% (Group B). The average tunnel placement in the tibial side: from the anterior edge 45% (Group A) and 45% (Group B), from the lateral side 57% (Group A) and 54% (Group B) (P=0.024). Graft failures ending up to revision ACL surgery: 4 (Group A) and 0 (Group B) (P=0.045). Operation time reduced 19min (P=0.001). Tunnel placement at the femoral side was already very low (anatomical) in patients operated in 2003. No significant difference was found when comparing to the patients operated in 2007. There were significantly more graft failures in the Group A, suggesting that the use of the DB method in ACL surgery in 2007 may have also improved the technique and results of the SB ACL reconstruction. Prospective comparative study, Level II.