Department of Sports Medicine & Joint Surgery, Hokkaido University School of Medicine, Kita-ku, Sapporo, Japan.
Arthroscopy. 2010 Sep;26(9 Suppl):S21-34. doi: 10.1016/j.arthro.2010.03.014.
Several double-bundle anterior cruciate ligament (ACL) reconstruction procedures were reported in the 1980s and 1990s. However, no significant differences were found in the clinical results between these double-bundle procedures and single-bundle procedures because the double-bundle procedures appeared to reconstruct only the anteromedial bundle with 2 bundles. In the early 2000s, we proposed a new concept of anatomic reconstruction of the anteromedial and posterolateral bundles, in which 4 independent tunnels were created through the center of each anatomic attachment of the 2 bundles. We called it "anatomic" double-bundle ACL reconstruction. Biomechanical studies have shown that the anatomic double-bundle ACL reconstruction can restore knee stability significantly more closely to the normal level than the conventional single-bundle reconstruction. Recent intraoperative measurement studies have shown that the clinically available anatomic double-bundle procedures can reconstruct knee stability significantly better and improve knee function close to the normal level at the time immediately after surgery compared with the conventional single-bundle procedures. However, the greatest criticism of the anatomic double-bundle reconstruction is whether its clinical results are better than the results of single-bundle reconstruction. To date (January 2010), 10 prospective comparative clinical trials (Level I or II) and 1 meta-analysis have been reported comparing single-bundle and anatomic double-bundle reconstructions using hamstring tendons. In 8 of the 10 studies, the anterior and/or rotatory stability of the knee was significantly better with the anatomic double-bundle ACL reconstruction than with the conventional single-bundle reconstruction. However, 1 original trial and the meta-analysis found that there were no differences in the results between the 2 types of reconstructions. Thus the utility of the anatomic double-bundle reconstruction has not yet been established. Our review does show how much evidence exists as to the benefits of double-bundle ACL reconstruction at present.
在 20 世纪 80 年代和 90 年代，报道了几种双束前交叉韧带（ACL）重建术。然而，这些双束手术与单束手术的临床结果并没有发现明显差异，因为双束手术似乎只重建了前内侧束和 2 束。在 21 世纪初，我们提出了一种新的前内侧束和后外侧束解剖重建的概念，其中通过 2 束的每个解剖附着中心创建了 4 个独立的隧道。我们称之为“解剖”双束 ACL 重建。生物力学研究表明，与传统的单束重建相比，解剖双束 ACL 重建可以更显著地恢复膝关节稳定性，接近正常水平。最近的术中测量研究表明，与传统的单束重建相比，临床可用的解剖双束手术可以更显著地重建膝关节稳定性，并在术后即刻接近正常水平改善膝关节功能。然而，解剖双束重建最大的批评是其临床效果是否优于单束重建。截至 2010 年 1 月，已有 10 项前瞻性对照临床试验（I 级或 II 级）和 1 项荟萃分析报道了使用腘绳肌腱比较单束和解剖双束重建。在 10 项研究中的 8 项中，与传统的单束重建相比，解剖双束 ACL 重建的膝关节前向和/或旋转稳定性显著更好。然而，1 项原始试验和荟萃分析发现，两种重建类型的结果没有差异。因此，解剖双束重建的实用性尚未得到确立。我们的综述确实表明，目前关于双束 ACL 重建益处的证据有多少。
