Double-Bundle Anterior Cruciate Ligament Reconstruction

BackgroundThe 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.HypothesisThe 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 DesignControlled laboratory study.MethodsTwenty 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.ResultsBoth 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).ConclusionThe 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 RelevanceThe effective role of the anatomical double-bundle procedure in better restoring knee kinematics should be questioned in an in vivo model.