Anterior Cruciate Ligament Reconstruction with Use of a Single or Double-Bundle Technique in Patients with Generalized Ligamentous Laxity

Sung-Jae Kim; Ji-Hoon Chang; Tai-Won Kim; Seung-Bae Jo; Kyung-Soo Oh
February 2009
Journal of Bone & Joint Surgery, American Volume;Feb2009, Vol. 91-A Issue 2, p257
Academic Journal
Background: In a patient with generalized ligamentous laxity, the risk of instability is greater with a conventionally reconstructed anterior cruciate ligament. The purpose of this study was to compare the clinical outcome of anterior cruciate ligament reconstruction done with a double-bundle technique with use of a quadriceps tendon-bone autograft and that of a single-bundle reconstruction with use of a bone-patellar tendon-bone autograft in patients with generalized ligamentous laxity. Methods: The records of sixty-one patients who underwent anterior cruciate ligament reconstruction between June 2002 and October 2005 were evaluated. Thirty-two patients underwent a single-bundle reconstruction (group 1), and twenty-nine patients underwent a double-bundle reconstruction (group 2). Clinical outcomes were determined from data obtained before surgery and at the twenty-four-month follow-up visit. Results: Postoperatively, the mean side-to-side difference (and standard deviation) in anterior tibial translation, measured with use of a KT-2000 arthrometer, was greater for group 1(3.37 ± 1.76 mm; range, 1.00 to 8.00 mm) than for group 2(2.03 ± 1.11 mm; range, 0.00 to 3.50 mm) (p= 0.02). Three patients in group 1 had a grade-1+ pivot shift, while no patient in group 2 had an abnormal pivot shift. The mean score on the Hospital for Special Surgery knee ligament questionnaire was 90.8 in group 1 and 92.1 in group 2, and the mean Lysholm score was 89.4 in group 1 and 91.1 in group 2. Conclusions: On the basis of the evaluation of ligamentous laxity measured by the KT-2000 arthrometer, a double-bundle anterior cruciate ligament reconstruction with use of a quadriceps tendon-bone autograft allows less anterior translation than does a single-bundle reconstruction with use of a bone-patellar tendon-bone autograft. However, we could not identify a significant difference in the functional outcome between the two techniques. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.


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