Anterior cruciate ligamentoplasty transtibial single tunnel and anatomical double tunnel: a comparative study
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Published:
Nov 12, 2019
Keywords:
Ligamentoplasty, retroscrew, bittunel technique
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Abstract
Objective: Comparison of two series of patients operated on ligamentoplasty with autologous hamstring tendons by the two preferred surgical techniques: transtibial monotunnel and anatomic bitunnel, using identical bone fixations; and establishment of functional conclusions.Material and method: Retrospective study of two series of 30 patients followed up more than one year, undergoing anterior cruciate ligamentoplasty with hamstring tendons performing transtibial montunnel and bitunnel techniques with retrograde tunneling, using the cortical elastic fixation in femur and a tibial fixation by retrograde screw, evaluating the patients by IKDC scale, Lachman, pivot and monopodal jump tests, valuating the reincorporation to the previous habitual and sports activity, and performing radiological examination of the evolution of the bone tunnels.Results: the anatomical bitunnel technique presents significantly (p <0.05) better results in the evaluation of the IKDC scale, in the pivot and in the jump test and in the recovery of sports activity prior to injury, with no differences in the Lachman test. There were no cases of osteolysis in the bone tunnels in none of the two series.Conclusions: The anatomical bitunnel ligamentoplasty technique is better valued by the patient and more efficient than the transtibial monotunnel technique, fundamentally in patients with demanding sports activity, since in patients without impact activities, the results are satisfactory in the same way. With tibial retrograde screwing, there was no significant osteolysis in the tibial tunnel.
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Anchuela Ocaña, J. J., Sieger, T. C., Martín Martínez, G., & Zorzo Godes, C. (2019). Anterior cruciate ligamentoplasty transtibial single tunnel and anatomical double tunnel: a comparative study. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 84(4), 361-371. https://doi.org/10.15417/issn.1852-7434.2019.84.4.939
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Clinical Research
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2. Noyes FR, Matthews DS, Mooar PA, Grood ES. The symptomatic anterior cruciate-deficient knee. Part II: The results of rehabilitation, activity modification and counseling of functional disability. J Bone Joint Surg 1983;12:623-34. https://doi.org/10.2106/00004623-198365020-00004
3. Meredick RB, Vance KJ, Appleby D, Lubowitz JH. Outcome of single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: a meta-analysis. Am J Sports Med 2008;36:1414-21. https://doi.org/10.1177/0363546508317964
4. Lane CG, Warren R, Pearle AD. The Pivot shift. J Am Acad Orthop Surg 2008;16(12):679-88. https://doi.org/10.5435/00124635-200812000-00001
5. Odensten M, Gilquist J. Functional anatomy of the anterior cruciate ligament and a rationale for reconstruction. J Bone Joint Surg Am 1985;67:257-9. https://doi.org/10.2106/00004623-198567020-00012
6. Amis A, Scammell B. Biomechanics of intra-articular and extra-articular reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 1993;75:812-7. https://doi.org/10.1302/0301-620x.75b5.8376447
7. Girgis FJ, Marshall JL, Al Monajem ARS. The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop 1975;106:216-31. https://doi.org/10.1097/00003086-197501000-00033
8. Maestro A, Álvarez A, Del Valle M, Rodríguez L, Meana A, García P, et al. Reconstrucción bifascicular del ligamento cruzado anterior. Rev Esp Cir Ortop Traumatol 2009;53(1):13-9. https://doi.org/10.1016/j.recot.2008.07.002
9. Arnold MP, KooloosJ, Van Kampen A. Single incision technique misses the anatomical femoral anterior cruciate ligament insertion: a cadaver study. Knee Surg Sports Traumatol Arthrosc 2001;9(4):194-9. https://doi.org/10.1007/s001670100198
10. Dienst M, Burks R, Greis P. Anatomy and biomechanics of the anterior cruciate ligament. Orthop Clin North Am 2002;33:605-20. https://doi.org/10.1016/s0030-5898(02)00010-x
11. Steiner MF, Battaglia TC, Heming JF, Rand JD, Festa A, Baria M. Independent drilling outperforms conventional transtibial drilling in anterior cruciate ligament reconstruction. Am J Sports Med 2009;37(10):1912-9. https://doi.org/10.1177/0363546509340407
12. Penner DA, Daniel DM, Wood P, Mishra D. An in vitro of anterior cruciate ligament graft placement and isometry. Am J Sports Med 1988;16(3):238-43. https://doi.org/10.1177/036354658801600307
13. Mediavilla I, Margalet E, Martín C. Resultados quirúrgicos de la reconstrucción del LCA mediante la técnica de doble fascículo. Cuadernos de Artroscopia 2011;8:2(45):23-30. https://pdfs.semanticscholar.org/5476/00fea0522fd0b723574854365ed932787cab.pdf?_ga=2.7450994.1397112067.1571419297-2023356659.1569938540
14. Ferreti A, Monaco E, Labianca L, De Carli A, Maestri B, Conteduca F. Double-bundle anterior cruciate ligament reconstruction: a computer-assisted orthopaedic surgery study. Am J Sports Med 2008;36:760-6. https://doi.org/10.1177/0363546507305677
15. Alburquerque RF, Ssaki SU, Amatuzzi MM, Angelini FJ. Anterior cruciate ligament reconstruction with double-bundle versus single bundle: experimental study. Clinic 2007;62:335-44. https://doi.org/10.1590/s1807-59322007000300020
16. Seon JK, Park SJ, Lee KB, Yoon TR, Seo HY, Song EK. Stability comparison of anterior cruciate ligament between double and single bundle reconstructions. Int Orthop 2009;33(2):425-9. https://doi.org/10.1007/s00264-008-0530-2
17. Ho JY, Gardiner A, Shah V, Steiner ME. Equal kinematics between central anatomic single bundle and double bundle anterior cruciate ligament reconstruction. Arthroscopy 2009;25(5):464-72. https://doi.org/10.1016/j.arthro.2009.02.013
18. Misonoo G, Kanamori A, Ida H, Miyakaya S, Ochiai N. Evaluation of tibial rotational stability of single-bundle vs anatomical double-bundle anterior cruciate reconstruction during a high-demand activity -a quasi-randomized trial. Knee 2012;19:87-93. https://doi.org/10.1016/j.knee.2011.01.003
19. Grassi A, Christian Carulli C, Innocenti M, Mosca M, Zaffagnini S, Bait C and SIGASCOT Arthroscopy Committee. New trends in anterior cruciate ligament reconstruction: a systematic review of national surveys of the last 5 years. Joints 2018;6:177-87. https://doi.org/10.1055/s-0038-1672157
20. Ayala-Mejías JD, García Estrada GA, Alcócer Pérez-España L. Lesiones del ligamento cruzado anterior. Acta Ortop Mex 2014;28(1):57-67. https://pdfs.semanticscholar.org/aaf4/f4797d67829a0a43c48798b59d0df4af1702.pdf?_ga=2.111337156.1397112067.1571419297-2023356659.1569938540
21. Mendoza P, Olarte JA, Gutierrez-Guevara JC. Percepción funcional de los pacientes tras reconstrucción del ligamento cruzado anterior. Serie de casos. Rev Colomb Ortop Traumatol 2017;31(1):16-21. https://doi.org/10.1016/j.rccot.2017.01.006
22. Berchuck M, Andriacchi TP, Bach BR, Reider B. Gait adaptations by patients who have a deficient anterior cruciate ligament. J Bone Joint Surg Am 1990;72:871-7. https://doi.org/10.2106/00004623-199072060-00012
23. López Hernández G, Fernández Hortigüela L, Gutiérrez JL, Forriol F. Protocolo cinético en la rotura del ligamento cruzado anterior. Rev Esp Cir Ortop Traumatol 2011;55(1):9-18. https://doi.org/10.1016/j.recot.2010.09.003
24. Morrison JB. The mechanics of the knee in relation to normal walking. J Biomech 1970;3:51-61. https://doi.org/10.1016/0021-9290(70)90050-3
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