Siebold Rainer, Dehler Carsten, Ellert Thomas
Orthopaedic Department, ARCUS Sportsclinic, Pforzheim, Germany.
Arthroscopy. 2008 Feb;24(2):137-45. doi: 10.1016/j.arthro.2007.11.013.
Biomechanical studies show increased anterior and rotational stability with double-bundle (DB) compared to single-bundle (SB) anterior cruciate ligament (ACL) reconstruction. The aim of this study was to evaluate the clinical results of four-tunnel DB ACL reconstruction.
Seventy patients undergoing arthroscopic hamstring ACL reconstruction were prospectively randomized to DB (n = 35) or SB (n = 35) groups. Each bundle fixation was by means of a femoral EndoButton CL and a tibial biodegradable interference screw. Demographic data were comparable between groups, and the average age of all patients was 29 years. The average follow-up was 19 months for both groups and included a history, clinical evaluation with knee scores, and radiographs.
The subjective results were similar in groups. The subjective International Knee Documentation Committee (IKDC) 2000 score was 88 P for DB versus 90 P for SB; the Lysholm score was 90 P for DB versus 93 P for SB; and the Cincinnati knee score was 91 P for DB versus 92 P for SB. The objective IKDC was significantly higher for DB: 78% "A" (P < .000) and 19% "B" compared to 24% "A" and 68% "B" for SB. The average KT-1000 side-to-side difference was 1.0 mm for DB and 1.6 mm for SB (P = .054) and the pivot shift test was negative in 97% for DB (P = .01) and 71% for SB. The range of motion was comparable for both groups.
Our study shows a significant advantage in anterior and rotational stability as well as objective IKDC for four-tunnel DB ACL reconstruction compared to SB ACL reconstruction. The subjective Cincinnati knee score, the Lysholm score, and the subjective IKDC 2000 did not show any statistical difference for one or the other technique.
Level I, randomized controlled trial.
生物力学研究表明，与单束（SB）前交叉韧带（ACL）重建相比，双束（DB）重建可增加前向和旋转稳定性。本研究旨在评估四隧道DB ACL重建的临床效果。
70例行关节镜下腘绳肌ACL重建的患者被前瞻性随机分为DB组（n = 35）和SB组（n = 35）。每束均通过股骨EndoButton CL和胫骨可生物降解挤压螺钉固定。两组患者的人口统计学数据具有可比性，所有患者的平均年龄为29岁。两组的平均随访时间均为19个月，随访内容包括病史、膝关节评分的临床评估以及X线片。
两组的主观结果相似。主观国际膝关节文献委员会（IKDC）2000评分，DB组为88分，SB组为90分；Lysholm评分，DB组为90分，SB组为93分；辛辛那提膝关节评分，DB组为91分，SB组为92分。客观IKDC评分DB组显著更高：78%为“A”级（P <.000），19%为“B”级，而SB组为24%为“A”级，68%为“B”级。DB组的平均KT-1000两侧差值为1.0 mm，SB组为1.6 mm（P =.054），DB组97%的轴移试验为阴性（P =.01），SB组为71%。两组的活动范围相当。
我们的研究表明，与SB ACL重建相比，四隧道DB ACL重建在前向和旋转稳定性以及客观IKDC评分方面具有显著优势。主观辛辛那提膝关节评分、Lysholm评分和主观IKDC 2000评分在两种技术之间未显示出任何统计学差异。
I级，随机对照试验。
