Anatomic reconstruction of the anterior cruciate ligament using double-bundle hamstring tendons: surgical techniques, clinical outcomes, and complications.

PURPOSE

The objective of the study was to retrospectively compare the clinical outcomes of anatomic double-bundle anterior cruciate ligament reconstruction via hamstring tendons with single-bundle reconstruction between April 2002 and March 2004.

METHODS

We retrospectively reviewed 123 consecutive patients, 71 of whom underwent double-bundle reconstruction and 52 of whom underwent single-bundle reconstruction. The same postoperative rehabilitation protocol was used for all patients. The patients were followed up for a mean of 33 months. We evaluated manual knee laxity, anterior knee laxity as measured with the KT1000 arthrometer (MEDmetric, San Diego, CA), range of knee motion, isokinetic peak torque of knee extension and flexion strength adjusted for body weight as determined by Cybex testing (Lumex, Ronkonkoma, NY), and Lysholm score.

RESULTS

The Lachman test was negative in 64 cases (90%) and the pivot-shift test was negative in 62 cases (87%) in the double-bundle group. The Lachman test was negative in 45 cases (86%) and the pivot-shift test was negative in 42 cases (81%) in the single-bundle group. There was an extension deficit of greater than 5 degrees in 19 cases (26%) in the double-bundle group and 6 cases (10%) in the single-bundle group (P < .05). The side-to-side difference in anterior tibial translation measured with the KT1000 arthrometer was 1.7 +/- 2.0 mm in the double-bundle group and 1.9 +/- 2.2 mm in the single-bundle group. The isokinetic peak torque of knee extension and flexion strength was 90% and 89%, respectively, in the double-bundle group and 87% and 86%, respectively, in the single-bundle group. The Lysholm score averaged 96.8 +/- 5.1 in the double-bundle group and 92.8 +/- 6.9 in the single-bundle group postoperatively.

CONCLUSIONS

No significant difference was found between the 2 procedures with regard to manual knee laxity, anterior knee laxity measured by the KT1000 arthrometer, knee extension and flexion strength, and Lysholm score. In contrast, there was a significant difference in the range of knee motion between the 2 groups. The findings of our study do not support the routine adoption of double-bundle reconstruction.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.