6 -fold SB ACL reconstruction versus "C shaped" DB ACL reconstruction with hamstrings in isolated ACL injuries. A prospective cohort study.
Author(s):
Siebold R. (Germany)
,
Siebold R. (Germany)
Affiliations:
Rodi T.
,
Rodi T.
Affiliations:
Feil S.
,
Feil S.
Affiliations:
Branch T.
Branch T.
Affiliations:
ESSKA Academy. Rodi T. 05/09/18; 209526; P07-943 Topic: Arthroscopic Surgery
Mr. Timo Rodi
Mr. Timo Rodi
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Abstract
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Objectives: Prospective comparison of clinical outcome and rotational stability of primary 6-fold single-bundle (SB) anterior cruciate ligament (ACL) reconstruction versus "C-shaped" double-bundle (DB) ACL reconstruction with anteromedial (AM) and posteromedial (PM) bundle.

Methods: Between 2011 and 2014, 91 patients who underwent primary ACL reconstruction after isolated ACL injuries met the inclusion criteria and were allocated into 2 groups according to the surgical procedure. 6-fold footprint SB reconstruction with hamstrings was used until 2012 and "C-shaped" DB with hamstrings thereafter. Follow-up consisted of a clinical evaluation with assessment of objective and subjective scores, KT-1000 arthrometer evaluation, MRI imaging and rotational knee stability testing using the RKT robotic system.

Results: The mean F/u time for 6-fold SB was 56.1 ± 10,2 months (n=34) and 33.2 ± 7.5 months for "C-shaped" flat DB (n=34). There were no significant differences between both groups in terms of KT-1000 side to side difference, automated dial test as measured by the RKT or in any of the validated subjective questionnaire results. However none of the "C-shaped" DB patients had uncontrolled anterior translation whereas 4 of the 6-fold SB patients did not have their anterior translation restored (p=0.05). There were 11 patients in the low satisfaction group. Of those, 8 had SB and 3 had DB reconstruction. Patients with < 8 mm anterior translation and >16 degrees of total tibial rotation had a 92% likelihood of being in the high satisfaction group (VAS>8), whereas patients with > 8 mm anterior translation or <16 degrees of total tibial rotation that likelihood dropped to 50%. Only one of the reached patients (n=77) suffered from a re-rupture of the reconstructed ACL (DB).

Conclusions: "C-shaped" DB ACL reconstruction with AM and PM reconstruction and 6-fold SB footprint ACL reconstruction achieved similar objective and subjective overall results. It is important to mention, that both procedures are different from the classical DB or SB techniques. The "C-shaped" DB was advantageous to reconstruct anterior translation and to achieve higher satisfaction after surgery compared to 6-fold SB. Longterm follow-up has to clarify the longevity and revision rate of the two different procedures.

Keywords:
ACL reconstruction, Double bundle, "c" shape", flat, 6-fold, Single bundle, Footprint reconstruction, Anteromedial bundle, Posteromedial bundle, Internal rotation, Rotational stability, RKT
Objectives: Prospective comparison of clinical outcome and rotational stability of primary 6-fold single-bundle (SB) anterior cruciate ligament (ACL) reconstruction versus "C-shaped" double-bundle (DB) ACL reconstruction with anteromedial (AM) and posteromedial (PM) bundle.

Methods: Between 2011 and 2014, 91 patients who underwent primary ACL reconstruction after isolated ACL injuries met the inclusion criteria and were allocated into 2 groups according to the surgical procedure. 6-fold footprint SB reconstruction with hamstrings was used until 2012 and "C-shaped" DB with hamstrings thereafter. Follow-up consisted of a clinical evaluation with assessment of objective and subjective scores, KT-1000 arthrometer evaluation, MRI imaging and rotational knee stability testing using the RKT robotic system.

Results: The mean F/u time for 6-fold SB was 56.1 ± 10,2 months (n=34) and 33.2 ± 7.5 months for "C-shaped" flat DB (n=34). There were no significant differences between both groups in terms of KT-1000 side to side difference, automated dial test as measured by the RKT or in any of the validated subjective questionnaire results. However none of the "C-shaped" DB patients had uncontrolled anterior translation whereas 4 of the 6-fold SB patients did not have their anterior translation restored (p=0.05). There were 11 patients in the low satisfaction group. Of those, 8 had SB and 3 had DB reconstruction. Patients with < 8 mm anterior translation and >16 degrees of total tibial rotation had a 92% likelihood of being in the high satisfaction group (VAS>8), whereas patients with > 8 mm anterior translation or <16 degrees of total tibial rotation that likelihood dropped to 50%. Only one of the reached patients (n=77) suffered from a re-rupture of the reconstructed ACL (DB).

Conclusions: "C-shaped" DB ACL reconstruction with AM and PM reconstruction and 6-fold SB footprint ACL reconstruction achieved similar objective and subjective overall results. It is important to mention, that both procedures are different from the classical DB or SB techniques. The "C-shaped" DB was advantageous to reconstruct anterior translation and to achieve higher satisfaction after surgery compared to 6-fold SB. Longterm follow-up has to clarify the longevity and revision rate of the two different procedures.

Keywords:
ACL reconstruction, Double bundle, "c" shape", flat, 6-fold, Single bundle, Footprint reconstruction, Anteromedial bundle, Posteromedial bundle, Internal rotation, Rotational stability, RKT
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