OBJECTIVE: To evaluate the stability achieved in isolated reconstruction of each ACL bundles (minimum 2-year follow-up). STUDY GROUP: 39 consecutive patients (28.1 years of mean age) underwent anteromedial (AM) and posterolateral (PL) bundle reconstruction surgery (31.71 months of mean follow-up). CONTROL GROUP: 36 non-concurrent patients using single-bundle (SB) technique (more than 2-year follow-up). Evaluation based on IKDC scores, taking anterior-posterior translation and rotational stability as primary endpoints, and epidemiological data, ischaemia time, waiting time for surgery and complications as secondary endpoints. RESULTS: SB, AM and PL groups showed an anteroposterior translation (APT) at 2 years of 2.3, 1.8 and 1.8 mm, respectively, with an APT reduction of 5.4, 2.9 and 2.3 mm, respectively, but with no difference between both types of partial reconstruction (p = 0.552). IKDC scores in the AM group were as follows: preoperative (11 cases in group A, 12 B, 3 C), postoperative (24 A, 2 B); IKDC in the PL group: preoperative (7 B, 6 C), postoperative (10 A, 3 B). Mobility restored in all cases, while in group B, 2 AM patients and 3 PL had a slight Pivot Shift. There were no differences in complications as compared to conventional techniques. DISCUSSION: All techniques showed global significant enhancement in rotational stability (p < 0.0005). Improvement in anterior-posterior translation in AM group and in rotational stability in PL group was achieved; both showed no relevant statistical significance. Residual translation shows directly proportional relationship with preoperative status, surgical ischaemia time and patient weight. CONCLUSION: Reconstruction of one ACL bundle or the other can restore knee stability and function. Care should be taken to detect where the PL bundle reaches maximum tension and in improving patient preoperative status and ischaemia time.
OBJECTIVE: To evaluate the stability achieved in isolated reconstruction of each ACL bundles (minimum 2-year follow-up). STUDY GROUP: 39 consecutive patients (28.1 years of mean age) underwent anteromedial (AM) and posterolateral (PL) bundle reconstruction surgery (31.71 months of mean follow-up). CONTROL GROUP: 36 non-concurrent patients using single-bundle (SB) technique (more than 2-year follow-up). Evaluation based on IKDC scores, taking anterior-posterior translation and rotational stability as primary endpoints, and epidemiological data, ischaemia time, waiting time for surgery and complications as secondary endpoints. RESULTS:SB, AM and PL groups showed an anteroposterior translation (APT) at 2 years of 2.3, 1.8 and 1.8 mm, respectively, with an APT reduction of 5.4, 2.9 and 2.3 mm, respectively, but with no difference between both types of partial reconstruction (p = 0.552). IKDC scores in the AM group were as follows: preoperative (11 cases in group A, 12 B, 3 C), postoperative (24 A, 2 B); IKDC in the PL group: preoperative (7 B, 6 C), postoperative (10 A, 3 B). Mobility restored in all cases, while in group B, 2 AM patients and 3 PL had a slight Pivot Shift. There were no differences in complications as compared to conventional techniques. DISCUSSION: All techniques showed global significant enhancement in rotational stability (p < 0.0005). Improvement in anterior-posterior translation in AM group and in rotational stability in PL group was achieved; both showed no relevant statistical significance. Residual translation shows directly proportional relationship with preoperative status, surgical ischaemia time and patient weight. CONCLUSION: Reconstruction of one ACL bundle or the other can restore knee stability and function. Care should be taken to detect where the PL bundle reaches maximum tension and in improving patient preoperative status and ischaemia time.
Authors: Pier Francesco Indelli; Michael F Dillingham; Gary S Fanton; David J Schurman Journal: Clin Orthop Relat Res Date: 2003-02 Impact factor: 4.176