Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft

can it restore normal knee joint kinematics?

Hemanth R. Gadikota, Jia Lin Wu, Jong Keun Seon, Karen Sutton, Thomas J. Gill, Guoan Li

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

BACKGROUND: Anatomical reconstruction techniques that can restore normal joint kinematics without increasing surgical complications could potentially improve clinical outcomes and help manage anterior cruciate ligament injuries more efficiently. HYPOTHESIS: Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft can more closely restore normal knee anterior-posterior, medial-lateral, and internal-external kinematics than can conventional single-bundle anterior cruciate ligament reconstruction. STUDY DESIGN: Controlled laboratory study. METHODS: Kinematic responses after single-bundle anterior cruciate ligament reconstruction and single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft were compared with the intact knee in 9 fresh-frozen human cadaveric knee specimens using a robotic testing system. Kinematics of each knee were determined under an anterior tibial load (134 N), a simulated quadriceps load (400 N), and combined torques (10 N.m valgus and 5 N.m internal tibial torques) at 0 degrees , 15 degrees , 30 degrees , 60 degrees , and 90 degrees of flexion. RESULTS: Anterior tibial translations were more closely restored to the intact knee level after single-tunnel double-bundle reconstruction with anatomical placement of hamstring tendon graft than with a single-bundle reconstruction under the 3 external loading conditions. Under simulated quadriceps load, the mean internal tibial rotations after both reconstructions were lower than that of the anterior cruciate ligament-intact knee with no significant differences between these 3 knee conditions at 0 degrees and 30 degrees of flexion (P > .05). The increased medial tibial shifts of the anterior cruciate ligament-deficient knees were restored to the intact level by both reconstruction techniques under the 3 external loading conditions. CONCLUSION: Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft can better restore the anterior knee stability compared with a conventional single-bundle reconstruction. Both reconstruction techniques are efficient in restoring the normal medial-lateral stability but overcorrect the internal tibial rotations. CLINICAL RELEVANCE: Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft could provide improved clinical outcomes over a conventional single-bundle reconstruction.

Original languageEnglish
Pages (from-to)713-720
Number of pages8
JournalAmerican Journal of Sports Medicine
Volume38
Issue number4
Publication statusPublished - Apr 2010
Externally publishedYes

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Anterior Cruciate Ligament Reconstruction
Knee Joint
Biomechanical Phenomena
Knee
Transplants
Anterior Cruciate Ligament
Torque
Hamstring Tendons
Robotics
Joints

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft : can it restore normal knee joint kinematics? / Gadikota, Hemanth R.; Wu, Jia Lin; Seon, Jong Keun; Sutton, Karen; Gill, Thomas J.; Li, Guoan.

In: American Journal of Sports Medicine, Vol. 38, No. 4, 04.2010, p. 713-720.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Anatomical reconstruction techniques that can restore normal joint kinematics without increasing surgical complications could potentially improve clinical outcomes and help manage anterior cruciate ligament injuries more efficiently. HYPOTHESIS: Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft can more closely restore normal knee anterior-posterior, medial-lateral, and internal-external kinematics than can conventional single-bundle anterior cruciate ligament reconstruction. STUDY DESIGN: Controlled laboratory study. METHODS: Kinematic responses after single-bundle anterior cruciate ligament reconstruction and single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft were compared with the intact knee in 9 fresh-frozen human cadaveric knee specimens using a robotic testing system. Kinematics of each knee were determined under an anterior tibial load (134 N), a simulated quadriceps load (400 N), and combined torques (10 N.m valgus and 5 N.m internal tibial torques) at 0 degrees , 15 degrees , 30 degrees , 60 degrees , and 90 degrees of flexion. RESULTS: Anterior tibial translations were more closely restored to the intact knee level after single-tunnel double-bundle reconstruction with anatomical placement of hamstring tendon graft than with a single-bundle reconstruction under the 3 external loading conditions. Under simulated quadriceps load, the mean internal tibial rotations after both reconstructions were lower than that of the anterior cruciate ligament-intact knee with no significant differences between these 3 knee conditions at 0 degrees and 30 degrees of flexion (P > .05). The increased medial tibial shifts of the anterior cruciate ligament-deficient knees were restored to the intact level by both reconstruction techniques under the 3 external loading conditions. CONCLUSION: Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft can better restore the anterior knee stability compared with a conventional single-bundle reconstruction. Both reconstruction techniques are efficient in restoring the normal medial-lateral stability but overcorrect the internal tibial rotations. CLINICAL RELEVANCE: Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft could provide improved clinical outcomes over a conventional single-bundle reconstruction.",
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