Double-bundle versus single-bundle anterior cruciate ligament reconstruction with allogeneic tendon via single femoral tunnel

doi:10.3969/j.issn.2095-4344.2017.34.018

Abstract

Abstract:

BACKGROUND: The anterior cruciate ligament (ACL) is an extremely important static structure that stabilizes the structure of the knee joint. Many scholars have found that an insufficient understanding of normal anatomical structure and biological characteristics of the ACL results in poor outcomes in the ACL reconstruction.

OBJECTIVE: To compare the clinical effects of single-bundle and double-bundle single-tunnel techniques in ACL reconstruction with allogeneic tendon.

METHODS: (1) Anatomy research: Six fresh knee joints were used for the experiments, and X-ray, CT and MRI were taken for each sample to confirm no osteoclasia, tumor and collapse of ACL. Then the ACL was stripped from the tibial bone and used to run hematoxylin-eosin staining and observe the fiber distribution of each piece of the ACL. (2) Clinical research: A total of 40 cases of ACL arthroscopic reconstruction were involved in this study, including 19 single-bundle ones and 21 double-bundle ones. The International Knee Documentation Committee 2000 subjective knee form (IKDC2000), Tegner and Lysholm evaluations were performed in all the patients. Paired t-test was used to analyze the IKDC, Tegner and Lysholm scores before operation and at follow-up time.

RESULTS AND CONCLUSION: Anatomy research: From the view of anatomy, there was no evidence to support the double beams of the ACL at the tibial end by hematoxylin-eosin staining. Clinical research: Forty patients (40 knee joints) were successfully followed for over 12 months, and their joint range of motion was normal. The IKDC, Tegner and Lysholm scores were all improved in both two groups after the surgery, while the Larson scores were significantly higher in the double-bundle group than the single-bundle group. To conclude, the single-tunnel double-bundle ACL reconstruction is better to restore the knee stability than the single-bundle ACL reconstruction. This is an easy operation that has the merits of operating conveniently, restoring the normal anatomy of the tibial end, and exhibiting excellent short-term therapeutic effects. However, its long-term effects are uncertain.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

Key words: Anterior Cruciate Ligament, Dissection, Knee Joint, Tissue Engineering

CLC Number:

R318

Song Yang, Jiang Huan, Du Qing-jun, Ou Ding-qiang, Huang Ming-guang, Zeng Qiu-tao.

Double-bundle versus single-bundle anterior cruciate ligament reconstruction with allogeneic tendon via single femoral tunnel

[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(34): 5519-5525.

Figures/Tables 4

References

[1]Huston LJ, Greenfield ML, Wojtys EM. Anterior cruciate ligament injuries in the female athlete. Potential risk factors.Clin Orthop Relat Res.2000;(372):50-63.

[2]Freddie H Fu, Christopher D Harner, Kelly G Vince. Knee Surgery. Volume One. America:Williams&Wilkins.1994:278

[3]Harter RA, Osterniq LR, James SL, et al. Long-term evaluation of knee stability and function following surgical reconstruction for anterior cruciate ligament insufficiency. Am J Sports Med.1998;16:434-443

[4]Higgins LD, Taylor MK, Park D, et al. Reliability and validity of the International Knee Documentation Committee (IKDC) Subjective Knee Form. Joint Bone Spine.2007;74(6):594-599.

[5]American board of orthopaedic surgery. research committee report in dip lomatic newsletter. Chapel Hill, NC: ABOS; 2004:8

[6]Barker JU, Drakos MC, Maak TG, et al. Effect of graft selection on the incidence of postoperative infection in anterior cruciate ligament reconstrustion. Am J Sports Med. 2010;38(2);281-286.

[7]Chang SK,Egami DK,Shaieb MD,et al.Anterior cruciate ligament reconstruction:allograft versus autograft,Arthroscopy. 2003;19 :453-462.

[8]Woo SL, Kanamori A, Zeminski J, et al. The effectiveness of reconstruction of the anterior cruciate ligament with hamstrings and patellar tendon. A cadaveric study comparing anterior tibial and rotational loads. J Bone Joint Surg Am. 2002:84:907-914

[9]Yagi M, Wong EK, Kanamori A, et al. Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med. 2002:30:660-666

[10]丁清和,叶勇光,向孝兵,等.关节镜下经前内入路建立股骨骨道重建前交叉韧带的疗效观察[J] .岭南急诊医学杂志, 2014,19 (4 ):323-234.

[11]Cha PS, Brucker PU, West RV, et al. Arthroscopic double-bundle anterior cruciate ligament reconstruction: an anatomic approach. Arthroscopy.2005;21 1275.e1-8.

[12]Ishibashi Y, Tsuda E, Tazawa K, et al. Intraoperative evaluation of the anatomical double-bundle anterior cruciate ligament reconstruction with the OrthoPilot navigation system. Orthopedics 2005;28:1277-1282.

[13]Yasuda K,Kondo E,Ichiyama H, et al.Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts. Arthroscopy 2004;20(10):1015-1025.

[14]尤田,张新涛,张文涛,等.中国成人前交叉韧带胫骨止点的解剖研究[J].中国修复重建外科杂志,2015,29(6):730-733.

[15]Zantop T, Petersen W, Sekiya JK, et al. Anterior cruciate ligament anatomy and function relating to anatomical reconstruction. Knee Surg Sports Traumatol Arthrosc.2006;14: 982-992.

[16]赵双利,王世轩,李洪涛 .前交叉韧带重建术中股骨隧道定位方法的发展趋势[J].中医正骨,2015, 27(8 ):63-65.

[17]李文凯,吴华,韦盛,等.关节镜下解剖位与过顶位前交叉韧带单束重建的近期疗效对比[J]骨科,2015, 6 (3):113-116.

[18]张理选,李映姗,张华胜,等.经前内侧入路个体化解剖重建前交叉韧带的临床分析[J] .右江民族医学院学报,2015, 37(3):419-427.

[19]OdenstenM, Gillquist J. Function anatomy of anterior cruciate ligament and a rationale for reconstruction. J Bone and Joint Surg.1985;67: 257-262.

[20]Howell SM, Taylor MA. Failure of reconstruction of the anterior cruciate ligament due to impingement by the intercondylar roof. J Bone Joint Surg Am.1993;75: 1044-1055.

[21]Amis AA, Zavras TD. Isometricity and graft placement during anterior cruciate ligament reconstruction. Knee.1995;2:5-17.

[22]Beynnon BD, Johnson RJ, Abate JA,et al. Treatment of anterior cruciate ligament injuries, part 2. Am J Sports Med. 2005;33:1751-1767.

[23]Fu FH, Bennett CH, Ma CB, et al. Current trends in anterior cruciate ligament reconstruction. Part II. Operative procedures and clinical correlations. Am J Sports Med 2000;28:124-130.

[24]Good L, Odensten M, Gillquist J. Sagittal knee stability after anterior cruciate ligament reconstruction with a patellar tendon strip. A two-year follow-up study. Am J Sports Med. 1994;22:518-523.

[25]Sommer C, Friederich NF, Müller W. Improperly placed anterior cruciate ligament grafts: correlation between radiological parameters and clinical results. Knee Surg Sports Traumatol Arthrosc 2000;8:207-213.

[26]Moisala AS, Järvelä T, Harilainen A,et al.The effect of graft placement on the clinical outcome of the anterior cruciate ligament reconstruction: a prospective study. Knee Surg Sports Traumatol Arthrosc.2007;15(7):879-887.

[27]马亮,许永涛,佘远举,等. 关节镜下经前内侧入路个体化解剖重建前交叉韧带的疗效观察[J]. 中国内镜杂志,2016, 22(3): 51-56.