Karikis Ioannis, Desai Neel, Sernert Ninni, Rostgard-Christensen Lars, Kartus Jüri
Department of Orthopaedics, NU-Hospital Group, Trollhättan/Uddevalla, Sweden Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden.
Am J Sports Med. 2016 May;44(5):1225-36. doi: 10.1177/0363546515626543. Epub 2016 Mar 6.
The aim of this prospective randomized study was to compare the outcomes of the anatomic double-bundle (DB) and anatomic single-bundle (SB) techniques 5 years after anterior cruciate ligament (ACL) reconstruction. Since more effective restoration of rotational laxity is considered the main advantage of the DB technique, the pivot-shift test was the primary outcome variable of the study.
Double-bundle ACL reconstruction will result in a better outcome in terms of the pivot-shift test.
Randomized controlled trial; Level of evidence, 1.
A total of 105 patients (33 women, 72 men; median age, 27 years; range, 18-52 years) were randomized and underwent ACL reconstruction (DB group, n = 53; SB group, n = 52). All reconstructions were performed anatomically by identifying the ACL footprints, using the anteromedial portal for the femoral tunnel drilling, and utilizing interference screw for tibial and femoral fixation. A single blinded observer examined the patients preoperatively and at follow-up (median, 64 months; range, 55-75 months). Multiple subjective and objective clinical evaluation tests and radiographic assessments of osteoarthritis (OA) were performed using the Ahlbäck, Kellgren-Lawrence, and Fairbank grading systems at 6 weeks postoperatively and at the final follow-up evaluation.
Preoperatively, no differences were found between the study groups, apart from the preinjury Tegner activity level, which was lower in the DB group (SB: mean, 7.8 [range, 3-9]; DB: mean, 7.3 [range, 0-9]; P = .02). Eighty-seven patients (83%) were available for examination at the 5-year follow-up. Statistical differences could not be found between the groups in terms of the pivot-shift test, KT-1000 arthrometer laxity measurements, manual Lachman test, single-legged-hop test, square-hop test, range of motion, Lysholm knee scoring scale, Tegner activity scale, or Knee injury and Osteoarthritis Outcome Score. Correspondingly, no differences were found between the groups regarding the presence of OA at follow-up. However, a significant increase of OA was found within the DB group at the 5-year follow-up. Both groups improved at follow-up compared with the preoperative assessment in terms of the laxity tests, hop tests, and scoring scales.
At the 5-year follow-up of an unselected group of patients, anatomic DB reconstruction was not superior to anatomic SB reconstruction in terms of the pivot-shift test.
这项前瞻性随机研究的目的是比较前交叉韧带（ACL）重建术后5年时解剖双束（DB）技术和解剖单束（SB）技术的疗效。由于更有效地恢复旋转松弛度被认为是DB技术的主要优势，因此轴移试验是本研究的主要结局变量。
就轴移试验而言，双束ACL重建将产生更好的疗效。
随机对照试验；证据等级，1级。
总共105例患者（33例女性，72例男性；中位年龄27岁；范围18 - 52岁）被随机分组并接受ACL重建（DB组，n = 53；SB组，n = 52）。所有重建均通过识别ACL足迹在解剖学上进行，使用前内侧入路钻股骨隧道，并使用挤压螺钉进行胫骨和股骨固定。一名单盲观察者在术前和随访时（中位时间64个月；范围55 - 75个月）对患者进行检查。在术后6周和最终随访评估时，使用阿尔贝克、凯尔格伦 - 劳伦斯和费尔班克分级系统进行多项主观和客观临床评估测试以及骨关节炎（OA）的影像学评估。
术前，研究组之间未发现差异，但受伤前的特格纳活动水平除外，DB组较低（SB组：均值7.8 [范围3 - 9]；DB组：均值7.3 [范围0 - 9]；P = 0.02）。87例患者（83%）在5年随访时可供检查。在轴移试验、KT - 1000关节测径仪松弛度测量、手法拉赫曼试验、单腿跳试验、四方跳试验、活动范围、Lysholm膝关节评分量表、特格纳活动量表或膝关节损伤和骨关节炎结局评分方面，两组之间未发现统计学差异。相应地，在随访时两组之间在OA的存在方面也未发现差异。然而，在5年随访时DB组内OA有显著增加。与术前评估相比，两组在随访时的松弛度试验、跳试验和评分量表方面均有改善。
在一组未经选择的患者的5年随访中，就轴移试验而言，解剖学DB重建并不优于解剖学SB重建。
