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Double-bundle reconstruction cannot restore intact knee kinematics in the ACL/LCL-deficient knee

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The aim of this study was to evaluate the effect of single-bundle (SB) and anatomic double-bundle (DB) anterior cruciate ligament (ACL) reconstruction on the resulting knee kinematics in a simulated clinical setting with ACL rupture and associated extra-articular damage to the lateral structures. It was hypothesized that anatomic DB ACL reconstruction restores the intact knee kinematics in ACL/LCL-deficient knees, whereas SB ACL reconstruction fails to restore the intact knee kinematics.

Materials and methods

Ten fresh-frozen human cadaver knees were subjected to anterior tibial load of 134 N (simulated KT 1000) and combined rotatory load of 10-Nm valgus and 4-Nm internal tibial torque (simulated pivot shift) using a robotic/UFS testing system. The resulting knee kinematics was determined for intact, ACL/LCL-deficient, SB ACL-reconstructed/LCL-deficient, and DB ACL-reconstructed/LCL-deficient knee. Statistical analysis was performed using a two-way ANOVA test with the level of significance set at P < 0.05.

Results

Under a simulated KT 1000 test, anterior tibial translation (ATT) following SB ACL reconstruction was statistically significant at 0°, 30° and 60° of knee flexion when compared to the intact knee. ATT after DB ACL reconstruction showed no statistically significant difference from the intact knee; however, there was a significant difference in SB reconstruction at 0° and 30° of knee flexion. Under a simulated pivot shift test, both SB and DB ACL reconstruction failed to restore the intact knee kinematics.

Conclusion

The results of the study did not support our initial hypothesis. Though DB reconstructions were significantly superior to SB reconstruction under simulated KT 1000 test, SB as well as DB reconstruction failed to restore the intact kinematics under simulated pivot shift loads. The clinical relevance of this study is that caution and precise preoperative diagnostics are needed to avoid failure of intra-articular ACL reconstruction if the extra-articular stabilizers are torn.

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Acknowledgments

Funding for the robotic/UFS testing system was received by a grant of the German Speaking Association for Arthroscopy (AGA) and is deeply appreciated by the authors.

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Authors and Affiliations

  1. Department of Trauma, Hand and Reconstructive Surgery, Wilhelms University Muenster, Waldeyer Strasse 1, 48149, Muenster, Germany

    Thore Zantop, Tobias Schumacher, Steffen Schanz & Michael J. Raschke

  2. Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital Berlin, Berlin, Germany

    Wolf Petersen

Authors
  1. Thore Zantop
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  2. Tobias Schumacher
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  3. Steffen Schanz
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  4. Michael J. Raschke
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  5. Wolf Petersen
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Correspondence to Thore Zantop.

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Winner of the AGA Medi Award 2009.

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Zantop, T., Schumacher, T., Schanz, S. et al. Double-bundle reconstruction cannot restore intact knee kinematics in the ACL/LCL-deficient knee. Arch Orthop Trauma Surg 130, 1019–1026 (2010). https://doi.org/10.1007/s00402-010-1081-8

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  • DOI: https://doi.org/10.1007/s00402-010-1081-8

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