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Double-bundle versus triple-bundle anatomical anterior cruciate ligament reconstruction using a hamstring autograft : a prospective randomized controlled trial
ESSKA Academy. Kamiya T. May 12, 2018; 218113
Tomoaki Kamiya
Tomoaki Kamiya
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Abstract
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Objectives: The anatomical anterior cruciate ligament (ACL) reconstruction could restore knee stability without loss of motion. The good clinical results of arthroscopic anatomical double-bundle (DB) and triple-bundle (TB) reconstruction using hamstring autograft were reported. However, there were no reports compared with two surgical procedures. The purpose of this study was to compare clinical outcomes between anatomical DB ACL reconstruction and TB ACL reconstruction.

Methods: From April 2013 to August 2015, 45 consecutive patients who underwent anatomical ACL reconstruction using hamstring autograft were examined. The patients were randomly divided into two groups (DB group or TB group). Femoral tunnels for anteromedial and posterolateral graft were created to all of patients. On the other hand, two (DB group) or three (TB group) tibial tunnels were made respectively. Every tunnel was created in anatomical ACL footprint using outside-in technique. The grafts were passed bone tunnels and fixed at 20 degrees of knee flexion with 20 Newtons of tensioning each graft using ligament tensioners. Range of motion, Lachman test, pivot shift test, knee laxity, and Tegner activity level scale were evaluated after two years from operation. Patient-reported outcome measure for ACL (JACL-25) were also obtained. Statistical analysis was performed with SPSS. Student t-test was used to compare both group. A p-value < 0.05 was considered statistical significance.

Results: 24 subjects (DB group) and 21 subjects (TB group) were included. There were no significant differences concerning about background of both group. Re-injury of ACL graft occurred five patients (DB group; 3, TB group; 2) within two years. Other patients were evaluated the physical examination and clinical outcomes after two years from operation. Loss of knee extension and flexion were not observed in all of patients. Lachman test was also negative in all of them. Three patients (DB group) and one patient (TB group) were presented glide pivot shift test. The others were negative. The average side-to-side difference in anterior laxity at manual maximum force with knee arthrometer were 1.1±1.0mm (DB group) and 0.9±1.1mm (TB group) respectively. There were no significant differences concerning about mean total score of JACL-25 (DB group; 26.0±27.0, TB group; 26.4±20.7). One questionnaire was significantly improved in TB group compared with DB group.

Conclusions: In this prospective randomized study, the primary variable, the pivot-shift test, and other subjective and objective outcome variables revealed no significant differences between the DB and TB techniques at 2 years after ACL reconstruction. Further studies involving larger sample sizes and longer-term follow-up are required.

Keywords:
anterior cruciate ligament, anatomical reconstruction, prospective randomized controlled trial
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