Effects of different initial bundle tensioning strategies on the outcome of double-bundle ACL reconstruction: a cohort study

• Main Authors: Muneta Takeshi, Koga Hideyuki, Ju Young-Jin, Yagishita Kazuyoshi, Sekiya Ichiro
• Format: Article
• Language: English
• Published: BMC 2011-07-01
• Series: Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology
• Online Access: http://www.smarttjournal.com/content/3/1/15

<p>Abstract</p> <p>Background</p> <p>This study was performed to investigate the effects of different strategies and initial tension applied to each one of the bundles, antero-medial (AM) and postero-lateral (PL), on clinical outcome in double bundle (DB) ACL reconstruction.</p> <p>Methods</p> <p>One hundred fifty-one primary unilateral DB ACL reconstructions performed by a single surgeon from 1994 through 2002 were included in the study with a follow-up of at least 24 months. They were divided in the following 3 groups: Group I - Higher initial tension applied manually in the AM bundle compared to PL. II - Higher tension applied in the PL bundle compared to AM. III - The 2 bundles were attempted to be equally tensioned. All fixations were performed in 30 degrees of flexion. Group I = 59 patients, group II = 53 patients and group III = 39 patients. The groups had no statistical differences concerning demographic distribution. Clinical outcome was retrospectively evaluated by use of knee range of motion, manual knee laxity tests, KT-1000, Lysholm knee scale, subjective recovery scale and sports performance recovery scale. The differences of data were analyzed among the three groups.</p> <p>Results</p> <p>Group I showed a significant extension deficit compared with groups II and III. ANOVA revealed a significant difference of anterior laxity measured by the KT-1000 (average KT difference of 2.1, 2.1 and 1.2 mm in Group I, II and III, respectively). A statistical difference was found among the three groups regarding subjective and sports performance recovery scales with Group II showing higher scores in recovery than Group I.</p> <p>Conclusions</p> <p>The current clinical study does not recommend manual maximum of initial tension applied to the anteromedial or posterolateral bundles with graft tension imbalance at 30 degrees of flexion in double-bundle ACL reconstruction to achieve a better clinical outcome.</p>