Institute of Sports Medicine of Peking University, Beijing, People's Republic of China.
Am J Sports Med. 2012 May;40(5):1084-92. doi: 10.1177/0363546512440686. Epub 2012 Apr 2.
BACKGROUND: Nonanatomic transtibial single-bundle anterior cruciate ligament reconstruction (SB-ACLR) with a bone-patellar tendon-bone (BPTB) allograft has been used for a long time and has shown the same satisfactory clinical results as an autograft; however, it has not been reported if a double-bundle ACLR (DB-ACLR) could be performed with a BPTB allograft and achieve even better results. HYPOTHESIS: The DB-ACLR with a BPTB allograft is technically feasible and will be superior to the SB technique in restoring better anterior and rotating stability. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: The study was performed with 56 patients, and 52 (25 in the DB group and 27 in the SB group) of them were followed up at 2 to 5 years. With an irradiated deep-frozen BPTB allograft, a standard single-incision arthroscopic technique was used, and the graft was fixed with bioabsorbable interference screws on both the femoral and tibial sides. Outcome assessment at final follow-up included International Knee Documentation Committee (IKDC), Tegner, and Lysholm scores; side-to-side difference by conventional KT-2000 arthrometer; total anteroposterior (AP) laxity by the back-pushing KT-2000 arthrometer; pivot shift (0, +, ++); range of motion (ROM); and isokinetic muscle strength evaluation. RESULTS: Mean follow-up was 47.3 ± 11.5 and 58.2 ± 6.6 months for the DB group and SB group, respectively. A statistically significant difference in favor of the DB group was found with the total AP laxity at 30° (P < .05). The overall incidence of pivot shift in the DB group (4% ++) was significantly lower than that in the SB group (26%: 19% + and 7% ++; P = .029). No significant differences were found between the 2 groups in terms of IKDC score, Lysholm score, Tegner score, conventional KT-2000 arthrometer anterior laxity, ROM, and muscle strength. CONCLUSION: A DB-ACLR with a BPTB allograft is feasible and achieved more satisfactory results than the transtibial SB technique in terms of total AP stability and rotational stability in spite of no significant differences among other clinical parameters.
背景：非解剖式胫骨结节单束前交叉韧带重建术（SB-ACLR）联合使用同种异体骨-髌腱-骨（BPTB）移植物已经使用了很长时间，并且已经显示出与自体移植物相同的令人满意的临床效果；然而，尚未有报道称是否可以使用同种异体 BPTB 移植物进行双束 ACLR（DB-ACLR）并获得更好的效果。
假设：使用同种异体 BPTB 移植物进行 DB-ACLR 在技术上是可行的，并且在恢复更好的前向和旋转稳定性方面将优于 SB 技术。
研究设计：队列研究；证据水平，2 级。
方法：该研究纳入了 56 例患者，其中 52 例（DB 组 25 例，SB 组 27 例）在 2 至 5 年时进行了随访。使用辐照深冷冻 BPTB 同种异体移植物，采用标准的单切口关节镜技术，将移植物在股骨和胫骨侧用可吸收的干扰螺钉固定。最终随访时的评估包括国际膝关节文献委员会（IKDC）、Tegner 和 Lysholm 评分；常规 KT-2000 关节计的侧-侧差值；后推 KT-2000 关节计的总前后（AP）松弛度；髌股关节（0、+、++）；活动范围（ROM）；和等速肌肉力量评估。
结果：DB 组和 SB 组的平均随访时间分别为 47.3 ± 11.5 个月和 58.2 ± 6.6 个月。在 30°时，DB 组的总 AP 松弛度有统计学意义的优势（P <.05）。DB 组髌股关节（4% ++）的整体发生率明显低于 SB 组（26%：19%+和 7% ++；P =.029）。两组之间在 IKDC 评分、Lysholm 评分、Tegner 评分、常规 KT-2000 关节计前向松弛度、ROM 和肌肉力量方面无显著差异。
结论：尽管在其他临床参数方面没有显著差异，但与胫骨结节 SB 技术相比，同种异体 BPTB 移植物的 DB-ACLR 在总 AP 稳定性和旋转稳定性方面具有更好的效果。
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