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Comparison of Clinical & Kinematic Outcomes Following Anatomic Single- vs. Double-Bundle ACL Reconstruction: A Randomized Clinical Trial
ESSKA Academy. Irrgang J. May 12, 2018; 218112; FP43-1106
James Irrgang
James Irrgang
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Abstract
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Objectives: The purpose of this double-blind randomized trial was to compare clinical and kinematic outcomes of anatomic single bundle (SB) to anatomic double bundle (DB) ACL reconstruction (ACLR).

Methods: Individuals between 14 and 50 years of age participating in at least 100 hours of Level 1 or 2 sports activities that presented within 12 months of ACL injury were recruited to participate in this study. If the ACL insertion sites were between 14 and 18mm, the subject was randomized to undergo anatomic SB or DB ACLR with a 10 mm quadriceps tendon autograft harvested with a patellar bone block. For DB ACLR, the graft was split into to two arms and passed through two anatomically placed tibial tunnels. Clinical outcomes, including the IKDC Subjective Knee Form (IKDC-SKF) and 30 pound (lb.) KT-1000 side to side difference and pivot shift tests were collected at 3, 6, 12 and 24-month follow-up. Dynamic stereo x-ray (DSX) was utilized to collect the kinematic outcomes 6 and 24 months after surgery while subjects performed downhill running on a treadmill (3.0 m/s, 10° slope, 150 images/s) and level walking (1.3 m/s, 100 images/s). Subject specific bone models were generated from computed tomography images and matched to the biplane radiographs to determine tibiofemoral kinematics. The primary kinematic outcome variables included the injured to contralateral knee differences in peak knee adduction (ADD), external rotation (ER) and anterior tibial translation (ATT) during heel-strike to mid-stance. Three trials were collected for each limb and each task, and averaged for analysis.

Results: Fifty-seven subjects were randomized (29 DB) and two-year clinical outcome data were collected from 51 (89.5%) and kinematic data were collected from 46 (80.7%). At 24-month follow-up there were no differences between the DB and SB groups for the IKDC-SKF (89.4 ± 10.3 vs. 90.2 ± 11.1, p=0.79), 30 lb. KT-1000 (0.5 mm ± 1.3 vs. 0.6 mm ± 1.6, p=0.80) or proportion of normal pivot shift tests (92.6% vs. 95.8%, p=0.48). There were no significant differences between DB and SB ACLR for any of the primary kinematic variables during walking or downhill running. At the 24-month follow-up during downhill running, the injured to contralateral knee differences for DB and SB ACLR were -0.2º±1.1 vs -0.2º±1.2 (p=0.71), -1.6º±4.0 vs -0.2º±3.1 (p=0.20) and 0.6 mm ±2.6 vs 2.0 mm±2.8 (p=0.13) for peak knee ADD, ER and ATT respectively. Three subjects (2 SB's, 5.9% of total) suffered a graft rupture and 5 individuals (4 SB's, 9.8% of total) had a subsequent meniscus injury.

Conclusions: With the available sample size, we were unable to demonstrate significant differences in clinical or kinematic outcomes between anatomic SB and DB ACLR when performed with a quadriceps tendon autograft with a bone block in individuals with ACL insertion sites that range from 14 to 18mm.

Keywords:
ACL Reconstruction, Randomized Trial, Single-Bundle, Double-Bundle, Clinical Outcomes, Kinematic Outcomes
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