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Primary Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction

A Preliminary 2-Year Prospective Study

From the Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania

^* Address correspondence to Freddie H. Fu, MD, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA 15213 (e-mail: ffu{at}upmc.edu).

Background: The anterior cruciate ligament consists of 2 functional bundles, the anteromedial bundle and the posterolateral bundle. Single-bundle anterior cruciate ligament reconstruction is the current standard for the treatment of anterior cruciate ligament deficiency. However, a significant subset of patients continues to report residual symptoms of instability after such reconstruction.

Hypothesis: Anatomic double-bundle anterior cruciate ligament reconstruction may more closely restore normal kinematics of the knee by reproducing the native anatomy.

Study Design: Case series; Level of evidence, 4.

Methods: We report the current clinical outcomes of the initial 100 consecutive patients who underwent anatomic double-bundle anterior cruciate ligament reconstruction with an average follow-up of 2.1 ± 0.5 years. All patients were prospectively followed to document range of motion, ligamentous laxity, and functional strength, as well as activity and sports participation.

Results: Side-to-side difference in range of motion was 2° ± 3° for extension and 2° ± 5° for flexion. Sixty-five percent of patients had a normal Lachman test result, and 33% were nearly normal. For the pivot-shift test findings, 94% were normal, and 6% were nearly normal. The average side-to-side difference in the KT-2000 arthrometer test was 1.0 ± 2.3 mm. There were 8 graft failures, 7 of which had subsequent revision surgery. No patients reported pain, swelling, or instability during activities of daily living, and 73% to 78% had no symptoms during very strenuous or strenuous sports activities. The scores of the International Knee Documentation Committee Subjective Knee Form, Activities of Daily Living, and Sports Activity Scores of the Knee Outcome Survey were 85.0, 91.8, and 87.0, respectively, and were similar compared with patients undergoing single-bundle anterior cruciate ligament reconstruction, which we have previously reported. Fifty-one percent described their current activity level as normal, and 35% reported it as nearly normal.

Conclusion: Anatomic double-bundle anterior cruciate ligament reconstruction results in good restoration of joint stability and patient-reported outcomes when evaluated 2 years after surgery.

Key Words: ACL • double bundle • outcome • ACL reconstruction