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

doi:10.3969/j.issn.2095-4344.0269

Abstract

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

CLC Number:

R318

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.

Figures/Tables 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."

References

[1] Adravanti P, Dini F, de Girolamo L, et al. Single-bundle versus double-bundle anterior cruciate ligament reconstruction: a prospective randomized controlled trial with 6-year follow-up. J Knee Surg. 2017;30(9):898-904.

[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.