Artros Center for Orthopaedic Surgery and Sports Medicine, Tehnoloski park 21, 1000 Ljubljana, Slovenia.
Am J Sports Med. 2012 Aug;40(8):1781-8. doi: 10.1177/0363546512446928. Epub 2012 May 16.
Reconstruction of the anterior cruciate ligament (ACL) has become a commonly performed procedure. However, biomechanical studies have demonstrated that conventional single-bundle ACL reconstruction techniques are only successful in limiting anterior tibial translation but less effective for restoring rotatory laxity.
This study aimed to compare the results of single- and double-bundle ACL reconstruction using an anatomic technique, individualized based on the patient's native ACL size. The authors hypothesized that there would be no difference between the results of anatomic single-bundle (ASB) and anatomic double-bundle (ADB) reconstruction when the surgical technique is individualized.
Cohort study; Level of evidence, 2.
Depending on intraoperative measurements of the ACL insertion site size, patients were selected for either ASB (n = 32) or ADB (n = 69) ACL reconstruction. In all groups, hamstring tendons autograft was used with suspensory fixation on the femoral side and bioabsorbable interference screw fixation on the tibial side. The outcomes were evaluated by an independent blinded observer using the Lysholm score, subjective International Knee Documentation Committee (IKDC) form, KT-1000 arthrometer for anteroposterior stability, and pivot-shift test for rotational stability. The average follow-up was 30 months (range, 26-34 months). There were no statistically significant differences in the baseline demographics of the 2 groups.
There was no significant difference between the ADB and ASB groups for Lysholm score (93.9 vs 93.5), subjective IKDC score (93.3 vs 93.1), anterior tibial translation (1.5- vs 1.6-mm side-to-side difference), and pivot shift (92% vs 90% with negative pivot-shift examination).
Anatomic double-bundle reconstruction is not superior to anatomic single-bundle reconstruction when an individualized ACL reconstruction technique is used.
前交叉韧带（ACL）重建已成为一种常见的手术。然而，生物力学研究表明，传统的单束 ACL 重建技术仅成功限制了胫骨前移，但对于恢复旋转松弛的效果较差。
本研究旨在比较基于解剖学的个体化单束（ASB）和双束（ADB）ACL 重建的结果。作者假设，当手术技术个体化时，解剖学单束（ASB）和解剖学双束（ADB）重建的结果没有差异。
队列研究；证据等级，2 级。
根据 ACL 插入部位大小的术中测量，患者被选择进行 ASB（n=32）或 ADB（n=69）ACL 重建。在所有组中，都使用了腘绳肌腱自体移植物，股骨侧采用悬吊固定，胫骨侧采用可吸收干扰螺钉固定。由独立的盲法观察者使用 Lysholm 评分、主观国际膝关节文献委员会（IKDC）评分、KT-1000 关节测量仪评估前后稳定性和前抽屉试验评估旋转稳定性。平均随访时间为 30 个月（范围，26-34 个月）。两组的基线人口统计学数据无统计学差异。
ADB 组和 ASB 组的 Lysholm 评分（93.9 对 93.5）、主观 IKDC 评分（93.3 对 93.1）、胫骨前移（1.5-对 1.6mm 侧-侧差异）和前抽屉试验（92%对 90%有阴性前抽屉试验）无显著差异。
当使用个体化 ACL 重建技术时，解剖学双束重建并不优于解剖学单束重建。
