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Double-Bundle Anterior Cruciate Ligament Reconstruction Using Hamstring Autografts and Bioabsorbable Interference Screw Fixation

Prospective, Randomized, Clinical Study With 2-Year Results

Timo Järvelä, MD, PhD^,,*, Anna-Stina Moisala, MD, Raine Sihvonen, MD, Sally Järvelä, MD, Pekka Kannus, MD, PhD^,|| and Markku Järvinen, MD, PhD

From the Orthopaedic Department and Arthroscopic Center, Hatanpää Hospital, the Sports Clinic and Hospital Mehiläinen, the Division of Orthopaedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere University, and the ^|| Injury and Osteoporosis Research Center, UKK Institute, Tampere, Finland

^* Address correspondence to Timo Järvelä, MD, PhD, Department of Orthopaedics, Hatanpää Hospital, PO Box 437, FIN-33101 Tampere, Finland (e-mail: timo.jarvela{at}sci.fi).

Background: Conventional anterior cruciate ligament reconstruction techniques have focused on restoration of the anteromedial bundle only, which, however, may be insufficient in restoring the rotational stability of the knee.

Hypothesis: Rotational stability of the knee is better when using a double-bundle technique instead of a single-bundle technique for anterior cruciate ligament reconstruction.

Study Design: Randomized controlled clinical trial; Level of evidence, 1.

Methods: Seventy-seven patients were randomized into 3 different groups for anterior cruciate ligament reconstruction with hamstring tendons: double-bundle with bioabsorbable screw fixation (n = 25), single-bundle with bioabsorbable screw fixation (n = 27), and single-bundle with metallic screw fixation (n = 25). The evaluation methods were clinical examination, KT-1000 arthrometric measurement, and the International Knee Documentation Committee and Lysholm knee scores.

Results: There were no differences between the study groups preoperatively. Seventy-three patients (95%) were available at a minimum 2-year follow-up (range, 24–35 mo). The rotational stability of the knee, as evaluated by the pivot-shift test, was the best in the patients in the double-bundle group. In addition, the patients in the single-bundle groups had more graft failures than those in the double-bundle group. Concerning the anterior stability of the knee as measured with the KT-1000 arthrometer, the group differences were not statistically significant. No significant differences were found between the groups in knee scores.

Conclusion: Rotational stability of the knee is better when using the double-bundle technique instead of the single-bundle technique in anterior cruciate ligament reconstruction.

Key Words: double-bundle technique • anterior cruciate ligament reconstruction • hamstring tendon autograft • prospective • randomized • clinical outcome

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