单束与双束重建前交叉韧带的长期结果相似：一项10年回顾性研究

doi:10.3969/j.issn.2095-4344.0269

中国组织工程研究 ›› 2018, Vol. 22 ›› Issue (23): 3692-3697.doi: 10.3969/j.issn.2095-4344.0269

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇下一篇

单束与双束重建前交叉韧带的长期结果相似：一项10年回顾性研究

曾会粮¹，冯文俊²，李萍³，陈锦伦²，曾建春²，李杰²，邓鹏¹，吴克亮¹，叶鹏程¹，揭珂¹，曹厚然¹，曾意荣²

¹广州中医药大学第一临床医学院，广东省广州市 510006；²广州中医药大学第一附属医院关节一科，广东省广州市 510405；³广州中医药大学第二临床医学院，广东省广州市 510006

出版日期:2018-08-18 发布日期:2018-08-18
通讯作者: 曾意荣，博士，主任医师，广州中医药大学第一附属医院关节一科，广东省广州市 510405
作者简介:曾会粮，男，1994年生，江西省瑞金市人，汉族，广州中医药大学在读硕士，主要从事髋膝关节疾病的研究。

Comparable long-term outcomes of single-bundle versus double-bundle anterior cruciate ligament reconstruction: a 10-year retrospective study

Zeng Hui-liang¹, Feng Wen-jun², Li Ping³, Chen Jin-lun², Zeng Jian-chun², Li Jie², Deng Peng¹, Wu Ke-liang¹, Ye Peng-cheng¹, Jie Ke¹, Cao Hou-ran¹, Zeng Yi-rong²

¹The First Clinical Medical College of Guangzhou University of Chinese Medicine，Guangzhou 510006, Guangdong Province, China; ²First Department of Joint Surgery, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China; ³The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China

Online:2018-08-18 Published:2018-08-18
Contact: Zeng Yi-rong, M.D., Chief physician, First Department of Joint Surgery, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
About author:Zeng Hui-liang, Master candidate, The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China

摘要/Abstract

摘要：

文章快速阅读：

文题释义：

前交叉韧带：起点位于股骨外髁髁间凹面的后内侧部分，止点位于胫骨髁间隆突之间及其前侧的坡面与内、外侧半月板前角之间。前交叉韧带一般宽约11 mm，长约38 mm。前交叉韧带股骨和胫骨附着点的面积是其中段横截面的3.5倍以上，形态不规则。根据其纤维走向的不同，可以把前交叉韧带大体分为前内侧束和后外侧束。

单束重建与双束重建：单束重建即在关节镜下，分别在前交叉韧带的股骨和胫骨止点处制备股骨和胫骨单隧道，将移植物穿入骨道，两端进行固定后，移植物即成为了重建的前交叉韧带，其中胫骨隧道位于原胫骨止点的前内侧与后外侧部分中央，最小直径为10 mm；双束重建即在关节镜下对前交叉韧带进行解剖重建，在股骨和胫骨分别依照前交叉韧带前内和后外束止点制作股骨双骨道和胫骨双骨道，将前内移植物和后外移植物分别引入各自的骨道进行重建，前内束胫骨骨道最小直径8 mm，后外束胫骨骨道最小直径6 mm。

摘要

背景：近年来，单束前交叉韧带重建技术的应用逐渐增加，且具有良好的临床结果，但是存在前方和旋转不稳。一些生物力学研究则表明双束前交叉韧带重建可增加膝关节稳定性。然而，目前尚缺乏关于2种技术临床结果的长期随访研究。
目的：比较单束与双束前交叉韧带重建后10年患者膝关节功能和临床结果，评估两种技术之间有效性的差异。
方法：回顾性搜集了47例自2007年1月至2009年9月在广州中医药大学第一附属医院骨伤中心行单束或双束前交叉韧带重建的患者。根据重建方式分为单束重建组和双束重建组，术前和术后评估包括体格检查(Lachman试验，轴移试验，前抽屉试验)、膝关节功能评分(Lysholm和Tegner评分)(和等速肌力测定(腘绳肌与股四头肌比率）。
结果与结论：2组患者术后体格检查未发现阳性体征。术后10年Lysholm和Tegner评分较术前明显升高，但2组术后Lysholm和Tegner评分结果接近，且等速肌力测定结果接近。表明单束和双束前交叉韧带重建均能改善患者膝关节功能，且2种方法的临床效果接近。

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
orcid: 0000-0001-7612-6505(Zeng Yi-rong)

关键词: 前交叉韧带损伤, 单束重建, 双束重建, 稳定性, 功能, 膝关节评分, 长期随访, 临床结果, 组织构建

Abstract:

BACKGROUND: In recent years, the application of single-bundle anterior cruciate ligament (ACL) reconstruction technique has been gradually increased and obtained good clinical results, but there exists anterior and rotational instability. Biomechanical study has shown that double-bundle ACL reconstruction could increase knee stability. However, there is no long-term follow-up study on the comparison of clinical outcomes of the two technologies.

OBJECTIVE: To compare knee function and clinical outcomes at postoperative 10 years in patients undergoing single-bundle and double-bundle ACL reconstruction, and to assess the differences of efficacies between the two techniques.

METHODS: The retrospective study included 47 patients receiving single-bundle and double-bundle ACL reconstruction in the Orthopedic Center of First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2007 to September 2009. Patients were divided into single-bundle group and double-bundle group according to the reconstruction method. Preoperative and postoperative evaluation included physical examination (Lachman test, pivot shift test and anterior drawer test), knee function scores (Lysholm and Tegner scores) and Isokinetic strength test (Hamstring/Quadriceps muscle strength ratio).

RESULTS AND CONCLUSION: No positive signs were found in the postoperative physical examination between both groups. Lysholm score and Tegner score after surgery were significantly higher at postoperative 10 years than that preoperatively in both groups. However, Lysholm and Tegner scores were similar, and isokinetic strength test results were identical between both groups. Both single-bundle and double-bundle anterior cruciate ligament reconstruction could improve knee function, and the clinical effects were similar between the two groups.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Anterior Cruciate Ligament, Knee Joint, Muscle Strength, Tissue Engineering

中图分类号:

R318

曾会粮，冯文俊，李萍，陈锦伦，曾建春，李杰，邓鹏，吴克亮，叶鹏程，揭珂，曹厚然，曾意荣. 单束与双束重建前交叉韧带的长期结果相似：一项10年回顾性研究[J]. 中国组织工程研究, 2018, 22(23): 3692-3697.

Zeng Hui-liang, Feng Wen-jun, Li Ping, Chen Jin-lun, Zeng Jian-chun, Li Jie, Deng Peng, Wu Ke-liang, Ye Peng-cheng, Jie Ke, Cao Hou-ran, Zeng Yi-rong. Comparable long-term outcomes of single-bundle versus double-bundle anterior cruciate ligament reconstruction: a 10-year retrospective study[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(23): 3692-3697.

图/表（结果） 2

Quantitative analysis of patients

A total of 47 patients were retrospectively reviewed, with completely preoperative data and postoperative follow-up data; no one included was lost to follow up. Totally 24 cases and 23 cases were included in single-bundle and double-bundle groups, respectively. No significant difference was found in both groups in age, gender, and follow-up period (Table 1).

Knee function

Postoperative physical examination (including drawer test and Lachman test) was negative in both groups. Compared to preoperative score, postoperative Lysholm score improved significantly in single-bundle group and double-bundle group (P < 0.05; Table 2). The two techniques improved knee function effectively. However, no significant difference in Lysholm score was found between single-bundle and double-bundle groups.

Postoperative Tegner scores were improved significantly than that preoperatively in single-bundle group and double-bundle group (P < 0.05). The results showed that both single-bundle ACL renconstruction and double-bundle ACL renconstruction restored knee stability. However, there were no significant difference between the two groups in Tegner score (P = 0.23 > 0.05; Table 3).

Isokinetic strength test

Isokinetic strength test (hamstring to quadriceps ratio (H/Q)) (Table 4) revealed no significant difference between the single-bundle group and the double-bundle group (P > 0.05). Thus, the result suggested that there was no significant difference in the balance of the flexor and extensor of the knee in the two groups.

Typical cases

Case 1

A 27-year-old male patient injured his left knee in a basketball game. Magnetic resonance imaging (MRI) showed rupture ACL (Figure 2A), accepted single-bundle ACL reconstruction (Figure 2B), MRI at postoperative 9 years showed intact ACL (Figure 2C).

Case 2

A 23-year-old male patient hurt his right knee in a marathon. MRI showed rupture ACL (Figure 2D) and received double-bundle ACL reconstruction (Figure 2E). Anteroposterior and lateral X-ray at postoperative 10 years showed intact ACL (Figure 2F).

Adverse reactions

All patients achieved good clinical outcomes in the 10-year follow-up. No complication such as infection, implant loosening, joint cyst or functional limitation happened.

参考文献

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[2] Tiamklang T, Sumanont S, Foocharoen T, et al. Double-bundle versus single-bundle reconstruction for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev. 2012;11:CD008413.

[3] Beynnon BD, Johnson RJ, Fleming BC, et al. Anterior cruciate ligament replacement: comparison of bone-patellar tendon-bone grafts with two-strand hamstring grafts. A prospective, randomized study. J Bone Joint Surg Am. 2002;84-A(9):1503-1513.

[4] Freedman KB, D'Amato MJ, Nedeff DD, et al. Arthroscopic anterior cruciate ligament reconstruction: a meta analysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med. 2003;31(1):2-11.

[5] Aune AK, Holm I, Risberg MA, et al. Four-strand hamstring tendon autograft compared with patellar tendon-bone autograft for anterior cruciate ligament reconstruction. A randomized study with two-year follow-up. Am J Sports Med. 2001;29(6):722-728.

[6] Yunes M, Richmond JC, Engels EA, et al. Patellar versus hamstring tendons in anterior cruciate ligament reconstruction: A meta-analysis. Arthroscopy. 2001;17(3):248-257.

[7] Yasuda K, Kondo E, Ichiyama H, et al. Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: comparisons among 3 different procedures. Arthroscopy. 2006;22(3):240-251.

[8] Mott HW. Semitendinosus anatomic reconstruction for cruciate ligament insufficiency. Clin Orthop Relat Res. 1983;(172):90-92.

[9] Björnsson H, Desai N, Musahl V, et al. Is double-bundle anterior cruciate ligament reconstruction superior to single-bundle? A comprehensive systematic review. Knee Surg Sports Traumatol Arthrosc. 2015;23(3):696-739.

[10] Kongtharvonskul J, Attia J, Thamakaison S, K et al. Clinical outcomes of double- vs single-bundle anterior cruciate ligament reconstruction: a systematic review of randomized control trials. Scand J Med Sci Sports. 2013;23(1):1-14.

[11] Mascarenhas R, Cvetanovich GL, Sayegh ET, et al. Does double-bundle anterior cruciate ligament reconstruction improve postoperative knee stability compared with single-bundle techniques? A systematic review of overlapping meta-analyses. Arthroscopy. 2015;31(6):1185-1196.

[12] Svantesson E, Sundemo D, Hamrin Senorski E, et al. Double-bundle anterior cruciate ligament reconstruction is superior to single-bundle reconstruction in terms of revision frequency: a study of 22,460 patients from the Swedish National Knee Ligament Register. Knee Surg Sports Traumatol Arthrosc. 2017;25(12):3884-3891.

[13] Järvelä S, Kiekara T, Suomalainen P, et al. Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective randomized study with 10-year results. Am J Sports Med. 2017;45(11):2578-2585.

[14] Briggs KK, Kocher MS, Rodkey WG, et al. Reliability, validity, and responsiveness of the Lysholm knee score and Tegner activity scale for patients with meniscal injury of the knee. J Bone Joint Surg Am. 2006;88(4):698-705.

[15] Heiser TM, Weber J, Sullivan G, et al. Prophylaxis and management of hamstring muscle injuries in intercollegiate football players. Am J Sports Med. 1984;12(5):368-370.

[16] Torkaman A, Yazdi H, Hosseini MG. The results of single bundle versus double bundle acl reconstruction surgery, a retrospective study and review of literature. Med Arch. 2016;70(5):351-353.

[17] Arciero RA. Double-bundle and single-bundle ACL reconstruction techniques did not differ in terms of clinical outcomes at 2 or 5 years. J Bone Joint Surg Am. 2016;98(22):1933-1934.

[18] Morey VM, Nag HL, Chowdhury B, et al. A prospective comparative study of clinical and functional outcomes between anatomic double bundle and single bundle hamstring grafts for arthroscopic anterior cruciate ligament reconstruction. Int J Surg. 2015;21:162-167.

[19] Kim D, Asai S, Moon CW, et al. Biomechanical evaluation of anatomic single- and double-bundle anterior cruciate ligament reconstruction techniques using the quadriceps tendon. Knee Surg Sports Traumatol Arthrosc. 2015;23(3):687-695.

[20] Liu Y, Cui G, Yan H, et al. Comparison between single- and double-bundle anterior cruciate ligament reconstruction with 6- to 8-stranded hamstring autograft: a prospective, randomized clinical trial. Am J Sports Med. 2016;44(9):2314-2322.

[21] Pinto MD, Blazevich AJ, Andersen LL, et al. Hamstring-to-quadriceps fatigue ratio offers new and different muscle function information than the conventional non-fatigued ratio. Scand J Med Sci Sports. 2018;28(1):282-293.

[22] Kannus P. Ratio of hamstring to quadriceps femoris muscles' strength in the anterior cruciate ligament insufficient knee. Relationship to long-term recovery. Phys Ther. 1988;68(6):961-965.

[23] Fischer F, Fink C, Herbst E, et al. Higher hamstring-to-quadriceps isokinetic strength ratio during the first post-operative months in patients with quadriceps tendon compared to hamstring tendon graft following ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2017. doi: 10.1007/s00167-017-4522-x.

[24] Kim HJ, Lee JH, Ahn SE, et al. Influence of anterior cruciate ligament tear on thigh muscle strength and hamstring-to-quadriceps ratio: a meta-analysis. PLoS One. 2016;11(1):e0146234.

[25] Kyritsis P, Bahr R, Landreau P, et al. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. Br J Sports Med. 2016;50(15):946-951.

[26] Ageberg E, Roos HP, Silbernagel KG, et al. Knee extension and flexion muscle power after anterior cruciate ligament reconstruction with patellar tendon graft or hamstring tendons graft: a cross-sectional comparison 3 years post surgery. Knee Surg Sports Traumatol Arthrosc. 2009;17(2):162-169.

[27] Machado F, Debieux P, Kaleka CC, et al. Knee isokinetic performance following anterior cruciate ligament reconstruction: patellar tendon versus hamstrings graft. Phys Sportsmed. 2018;46(1):30-35.

[28] Gokeler A, Welling W, Zaffagnini S, et al. Development of a test battery to enhance safe return to sports after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2017;25(1):192-199.

[29] Kocher MS, Steadman JR, Briggs K, et al. Determinants of patient satisfaction with outcome after anterior cruciate ligament reconstruction. J Bone Joint Surg Am. 2002;84-A(9):1560-1572.

[30] Mascarenhas R, Cvetanovich GL, Sayegh ET, et al. Does double-bundle anterior cruciate ligament reconstruction improve postoperative knee stability compared with single-bundle techniques? A systematic review of overlapping meta-analyses. Arthroscopy. 2015;31(6):1185-1196.

引言

Anterior cruciate ligament (ACL) injury commonly happened in sports and accident, especially in basketball, soccer, badminton, and a variety of traffic accidents that cause fractures as well as ACL injury. With the improvement in understanding of the importance of ACL, the treatment of ACL injury has tansfered from nonoperation to arthroscopic surgery. Among many mature surgical techniques to reconstruct ACL, arthroscopic single-bundle ACL reconstruction has been regarded as the golden standard of ACL reconstruction^[1], and it has been the most utilized method^[2].

Some studies suggest that single-bundle ACL reconstruction provides reliable knee stability and function, though complications such as persistent pain were found in approximately 15% to 25% patients^[3-6]. Yasuda et al.^[7]ascribed the relative high failure rate to the unreasonable management of internal rotational forces due to genu valgum. Thus, graft choice, operative techniques, and fixed material need to be improved.

Compared with the reconstruction of one-bundle ACL in single-bundle group, double-bundle group, which has been developed about 30 years^[8], reconstructed both the anteromedial and the posterolateral bundles; therefore, the knee joint was restored anatomically and functionally. However, acceptance was gained widely only recent years. There are various differences in procedure skill, which causes no standardized and reproducible outcomes till now. Some studies showed superior knee stability of double-bundle ACL reconstruction, because it is more close to the native knee anatomy^{[2, 9-11]}. Eleonor et al.^[12]reported that double-bundle ACL reconstruction was associated with a lower risk of revision surgery than single-bundle ACL reconstruction oriented from primary ACL reconstruction to the revision time.

A recent study also showed fewer graft failures in double-bundle ACL reconstruction when compared to single-bundle ACL reconstruction, but similar knee stability and osteoarthritis grades at 10 years^[13]. The latest 6-year follow-up study did not reveal any significant differences in the aspect of function, stability and subjective findings when comparing single-bundle group with double-bundle group^[1]. Longer follow-up is needed.

As far as we know, most studies regarding comparison of knee stability and function between single-bundle and double-bundle ACL reconstruction were short and mid-period follow-up study, while the long-term results were still uncertain and deficient. Therefore, this study aimed to make an attempt to compare the long-term knee function and stability of single-bundle and double-bundle ACL reconstruction techniques in a 10-year follow-up period under objective and subjective evaluation.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

材料方法

Design

This is a retrospective analysis.

Time and setting

This experiment was performed in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2007 to September 2009.

Subjects

Totally 47 patients suffered ACL rupture and underwent ACL reconstruction in Orthopedic Center of First Affiliated Hospital of Guangzhou University of Chinese Medicine were retrospectively reviewed.

Inclusion criteria include: age between 16 and 45 years, complete ACL rupture within 3 months, primary single-bundle or double-bundle ACL reconstruction. The exclusion criteria include: meniscal tear requiring repairment or partial meniscectomy, fracture or dislocation of other parts in the affected knee, nerve injury, postoperative infection, other ligament injuries, rheumatic diseases, history of surgery in the affected knee, and mental disorder that cannot cope with postoperative rehabilitation. We divided patients into single-bundle group and double-bundle group. Patients were informed for the scientific research use of their hospital data, and written informed consent was obtained in all patients.

Methods

Surgical technique

One experienced surgeon performed all the procedure. A tourniquet and then arthroscopic examination was routinely performed after spinal anesthesia. Through anterolateral arthroscopy approach, a longitudinal incision (about 5 cm length) was made 1.5 cm below tibial tubercle to expose “pes anserinus”. Semitendinosus tendon and gracilis tendon were dissociated by the tendon lifter. It was divided into two strips and woven into eight strands, then pre-tensioned for 10 minutes.

For single-bundle ACL reconstruction, with the help of a specified elbow aimer, we prepared the tibial tunnel in the posterior 1/2 part of the original ACL attachment. The femoral and tibial tunnel was drilled, and the tunnel size was in line with the graft size.

The femoral tunnel was prepared through tibia to 11 clock in right knee and 13 clock in left knee. The tunnel was enlarged as needed. The new ligament was grafted through the tunnel and fixed to the femoral condylar and the tibial side. At last, the knee was checked to confirm no obstruction during knee flexion, favorable tension of the tendon, Lachman test and anterior drawer test (Figure 1A, B).

For double-bundle ACL reconstruction, the anteromedial and posterolateral tunnels were placed with the help of a standard tibial elbow aimer. An outside-in technique with a specified femoral aimer was used to drill the posterolateral femoral tunnel. A transtibial technique through the posterolateral tibial tunnel was used to drill the anteromedial tunnel. The tunnels with 7-mm drill were enlarged, and the tunnels were about 3 cm deep. The tendon was knitted into the two tunnels through guide needle. The mark end of the tendon was taken into femoral tunnel. The tendon bone was tighten and fixed with Endobutton, screws and staples as above (Figure 1C, D). Final stability and graft tention tests were the same as SB reconstruction technique.

Rehabilitation

All patients accepted the same rehabilitation protocols postoperatively. With the aid of brace, patients started isometric muscle training and range of motion exercise at postoperative days, and the range of motion should reach 90 degrees at 1 month, and 110 degrees at 2 months with weight bearing walking. The range of motion must reach 120 degrees at postoperative 3 months while fully-weight bearing walking without brace. Patients were allowed to return normal life and proper sports activities within 6 months.

Clinical evaluation

The knee function was evaluated with the universally accepted Lysholm score (Range: 0–100 points, excellent: 95–100, good: 84–94, fair: 65–83, poor: < 65; including 8 aspects: limp, locking, pain, stair-climbing, support, instability, swelling, and squatting) and Tegner score (Ranging from 0 (means sick leave or disability pension caused by knee problems) to 10 (very high level competitive sports)^[14]preoperatively and at 3, 6 months, 1 year, and annually thereafter postoperatively. The postoperative quadriceps peak torque ratio (Hamstring-to-quadriceps, H/Q) of patients with isokinetic strength test system was also assessed (defined normal value of H/Q ratio as greater than 60%)^[15].

Main outcome measures

There were (1) knee joint function score; (2) isokinetic strength.

Statistical analysis

Data were analyzed by SPSS17.0. Measurement data (Lysholm and Tegner score, quadriceps peak torque ratio) were tested by t-test, and expressed with the mean ± standard deviation.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

讨论

Many studies have demonstrated the better knee stability and kinematics of double-bundle ACL reconstruction than single-bundle ACL reconstruction. However, several studies reported comparable short-term results between the two techniques^[16-17]. However, consensus on the long-term clinical outcomes of the two techniques is still deficient. In this study, the long-term clinical outcomes in Lysholm score, Tegner score and Isokinetic strength test revealed no significant difference between the single-bundle group and double-bundle group, regardless of postoperatively significantly improved results. To our best knowledge, this is the first study compared clinical outcomes of single-bundle and double-bundle ACL reconstruction at a 10-year follow-up.

It is known to us that single-bundle ACL reconstruct technique used autogenous tendons is a mature repeatable procedure, has been performed commonly, and can achieve well knee stability. The double-bundle ACL technique is relatively young, usually performed by experienced surgeons. Optimistic outcomes have been drawn from several cadaveric studies and some clinical data, but laboratory evidence is still lack to demonstrate the enormous advantage of double-bundle technique, which is complicated and technique demanded. Thereafter, studies about the long-term outcome of the two techniques are less.

In our present study, postoperative values of Lysholm score and Tegner score of both groups improved significantly than data preoperatively. Values of Isokinetic strength test in two groups were far better than normal H/Q value.

There are several prospective studies reported a better result in double-bundle group than single-bundle group in biomechanical and functional outcomes^[18-19]. Kim et al.^[19]suggested the advantage of double-bundle group in restoring biomechanics of the knee. Nevertheless, in a mid-long term follow-up study, Liu et al.^[20] randomly included 80 patients who underwent either single-bundle or double-bundle ACL reconstruction with subjective scores and objective tests. They found both techniques acquired satisfactory outcomes, neither technique was superior, which was similar to our study.

H/Q isokinetic strength ratio offers function information mainly of muscle strength of the knee^[21]. It has been commonly used in the evaluation of ACL injury and reconstruction^[22-24], so it provided objective outcomes for the present study. High H/Q ratios of single-bundle and double-bundle groups fully proved the similar excellent muscle strength in the 10-year follow-up.

Patient reported outcome measures scores are able to evaluate patients’ feeling, knee sability and function pre- and post-operatively. The patient reported outcome measures scores have been commonly used in objective evaluation^[29], such as the commonly used visual analog scale for pain, knee injury and osteoarthritis score, Lysholm and Tegner scores. This study used the Lysholm score and the Tegner score, and there was no significant difference between the two groups. Mascarenhas et al.^[30]studied nine meta-analysis studies, which compared double-bundle and single-bundle ACL technique, showed no signifcant difference between the two techniques in Tegner score and Lysholm score, which was consistent with our study. The long-term follow-up study was conducted in comparing clinical outcomes of single-bundle ACL reconstruction and double-bundle ACL reconstruction technique. Both subjective and objective outcomes were evaluated. No one was lost to follow up.

There are several limitations in this study. First, the sample size was small, mainly because the limited numbers of double-bundle procedures, which took long operation time and complicated operation with the technique 10 years ago. Secondly, our results are substantially in consistent with those large-sample size studies, and do not reveal significant difference. Thirdly, MRI or arthroscopy was not performed as part of the follow-up, and we were therefore unable to evaluate the ligament status.

Our retrospective study showed a great improvement in postoperative clinical outcomes in both double-bundle and single-bundle groups, but there was no statistically significant difference between them in long-term follow-up.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

单束与双束重建前交叉韧带的长期结果相似：一项10年回顾性研究

Comparable long-term outcomes of single-bundle versus double-bundle anterior cruciate ligament reconstruction: a 10-year retrospective study

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