Comparison of Tunnel Enlargement between Single and Double Bundle Anterior Cruciate Ligament Reconstruction

Ju-Hong Lee; Seong-Il Wang; Jong-Hyuk Park; Hyeon-Kyeong Bae

doi:10.4055/jkoa.2011.46.4.312

Journal List > J Korean Orthop Assoc > v.46(4) > 1013085

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Lee, Wang, Park, and Bae: Comparison of Tunnel Enlargement between Single and Double Bundle Anterior Cruciate Ligament Reconstruction

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2011; 46(4): 312-319.

Published online: 31 August 2011

DOI: https://doi.org/10.4055/jkoa.2011.46.4.312

Comparison of Tunnel Enlargement between Single and Double Bundle Anterior Cruciate Ligament Reconstruction

Ju-Hong Lee, M.D., Seong-Il Wang, M.D., Jong-Hyuk Park, M.D., Hyeon-Kyeong Bae, M.D.

Department of Orthopedic Surgery, Medical School, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Jeonju, Korea.

Correspondence to: Jong-Hyuk Park, M.D. Department of Orthopedic Surgery, Medical School, Research Institute of Clinical Medicine, Chonbuk National University Hospital, 634-18, Keumam-dong, Duckjin-gu, Jeonju 561-712, Korea. TEL: +82-63-250-1760, FAX: +82-63-271-6538, jhlee55@chonbuk.ac.kr

Received 9 June 2010 Accepted 2 March 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aim of this study was to compare the tunnel enlargement in patients who had undergone a double-bundle (DB) or single-bundle (SB) anterior cruciate ligament (ACL) reconstruction, and to determine the correlation between the extent of bone tunnel enlargement and the clinical results.

Materials and Methods

Among 224 primary ACL reconstructions performed from January 2004 to May 2008 we examined in this study 38 patients who underwent a SB-ACL reconstruction and 30 patients underwent a DB-ACL reconstruction. They were followed up over 1 year. The evaluation methods were the Lachman test, pivot-shift test and KT-1000 measurement for knee stability and the Lysholm score and International Knee Documentation Committee (IKDC) ratings for the functional results. Tunnel enlargement was measured at the sclerotic ridge of the most widest area on the anteroposterior and lateral radiographs in longitudinal and vertical axis of the tunnel.

Results

The tunnel enlargement on the femoral side was similar in the DB-ACL group and the SB-ACL group. On the other hand, on the tibial side, the tunnel enlargement was less in the DB-ACL group than in the SB-ACL group (p=0.001, ICC: 0.94). The two groups showed different functional results and extent of stability recovery. The KT-1000 arthrometer revealed 1.1 mm and 93% of negative in the pivot-shift test for the DB-ACL group, which induced an improved tendency compared to the SB-ACL group. No correlation was found between the tunnel enlargement and clinical results.

Conclusion

A DB-ACL reconstruction results in less tunnel enlargement on the tibial side than a SB-ACL reconstruction. There was no correlation between the tunnel enlargement and clinical results.

Keywords: anterior cruciate ligament, reconstruction, single-bundle, double-bundle, tunnel enlargement

Figures and Tables

Figure 1

The measurement of the tunnel enlargement. (A, B) Anteroposterior and lateral views of the single-bundle anterior cruciate ligament reconstruction group. (C, D) Anteroposterior and lateral views of the double-bundle anterior cruciate ligament reconstruction group.

Figure 2

Serial Changes of tunnel enlargement according to timeline on femur. SB, single bundle; AMB, anteromedial bundle; PLB, posterolateral bundle.

Figure 3

Serial Changes of tunnel enlargement according to timeline on tibia. SB, single bundle; AMB, anteromedial bundle; PLB, posterolateral bundle.

Table 1

Demographic Data of Patients

DB, double bundle; SB, single bundle; MM, medial meniscus; LM, lateral meniscus.

Table 2

Widening Femoral and Tibial Tunnels

Interclass correlation coefficiency: 0.94 (0.84-0.98). ^*Mean value±SD; ^†Tunnel diameter on postoperative roentgenogram is the final size of the dilator used; ^‡p=0.001 (Unpaired T-test). AMB, anteromedial bundle; PLB, posterolateral bundle; SB, single bundle.

Table 3

Correlation of Lysholm Scores and Amount of Femoral Tunnel Widening

DB, double bundle; SB, single bundle; AMB, anteromedial bundle; PLB, posterolateral bundle.

Table 4

Correlation of KT-1000 Measurement and Amount of Femoral Tunnel Widening

DB, double bundle; SB, single bundle; AMB, anteromedial bundle; PLB, posterolateral bundle.

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