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Condyle-Pinching Double-Bundle Anterior Cruciate Ligament Reconstruction.

ABSTRACT: The outcomes of anterior cruciate ligament (ACL) reconstruction are still unsatisfactory. Anterolateral ligament (ALL) reconstruction has been applied to augment ACL reconstruction, with better but still nonoptimal results. An anatomical analysis revealed that the route of ALL is quite different from that of ACL on the lateral view of the knee. Thus, we hope to augment ACL reconstruction with the reconstruction of an ACL-mimicking anterolateral structure, in which the route is similar to that of ACL. Thus, we aimed to introduce a combined ACL and ACL-mimicking anterolateral structure reconstruction technique, which we named condyle-pinching double-bundle ACL reconstruction. The main indication of this technique is ACL injury with a high degree of pivot shift or general laxity. The main steps of this technique include preparation of a combined graft, creation of a common femoral tunnel and 2 tibial tunnels, graft placement, and final graft fixation to an adjustable loop. We have been obtaining obvious outcome improvement clinically with this technique and consider that this report will provide special option in ACL reconstruction.

SUBMITTER: Tang J

PROVIDER: S-EPMC7451757 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Combined Double-Bundle Anterior Cruciate Ligament Reconstruction and Anterior Cruciate Ligament-Mimicking Anterolateral Structure Reconstruction.

Project description:The outcomes of double-bundle anterior cruciate ligament (ACL) reconstruction leave room for improvement. We hope to augment double-bundle ACL reconstruction with the reconstruction of an ACL-mimicking anterolateral structure (ALS). Thus, we would like to introduce a combined double-bundle ACL reconstruction and ACL-mimicking ALS reconstruction technique. The main indication for this technique is ACL injury with a high degree of pivot shift test, general laxity, or near critical value of the posterior tibial slope. The main steps in this technique include preparation of an isolated graft for the anteromedial bundle of the ACL and a combined graft for the posterolateral bundle of the ACL and ALS, creation of three tibial tunnels and two femoral tunnels, graft placement, and final graft fixation at an adjustable loop. We have obtained promising clinical outcomes with this technique and consider that this report will provide new options in ACL reconstruction.

| S-EPMC7451438 | biostudies-literature

Combined Double Bundle Anterior Cruciate Ligament Reconstruction and Anterolateral Ligament Reconstruction.

Project description:A double-bundle anterior cruciate ligament (ACL) reconstruction associated with an anterolateral ligament (ALL) reconstructions is performed. The semitendinosus and gracilis are harvested. At knee maximum flexion, the anteromedial (AM) femoral tunnel is performed in the AM footprint area. Through the anterolateral portal, the tip of the outside-in femoral guide is placed in the posterolateral footprint area. The guide sleeve is pushed onto the lateral femoral cortex at the ALL attachment. At 110° knee flexion, the posterolateral-ALL tunnel is performed. The tibial ACL tunnel is performed as usual. The tibial guide is placed between the ALL tibial attachment and the tibial ACL tunnel entrance to perform the ALL tibial tunnel. The gracilis graft is introduced from caudal to cranial, achieving fixation with a 6-mm diameter screw (outside-in). The AM femoral fixation is achieved with a suspension device. ACL tibial graft fixation is achieved with a screw. Afterward, the gracilis is passed under the fascia lata to the tibial entry point. A 6-mm diameter screw is placed from the external cortex into the tibial ALL tunnel. The biomechanical advantage of the double-bundle ACL reconstruction with the biomechanical advantage of the ALL anatomic reconstruction is achieved.

| S-EPMC6112256 | biostudies-literature

"Y" Graft Double Bundle Anterior Cruciate Ligament Reconstruction.

Project description:Single-bundle (SB) anterior cruciate ligament (ACL) reconstruction has been a standard procedure. However, residual rotary instability in approximately 20% of the cases (irrespective of the graft choice and the surgical technique) forces the surgeon to improve the biomechanical quality of the reconstruction. In parallel, adjustable suspensory fixation (ASF) devices have arisen. Biomechanics has defined (both anatomical and functional) the anteromedial (AM) and posterolateral (PL) bundles that work synergistically. In the unsymmetrical "anatomic" SB ACL reconstruction, the distribution of the ACL graft fibers (for AM or PL behavior) is not under the control of the surgeon. Furthermore, different sizes of the original footprints (depending on height) suggest the need to customize the graft footprint. This customization is only possible if distances are measured during surgical procedures. We present an inside-out technique for DB ACL reconstruction ("all-inside" also possible). Semitendinosus is folded to obtain a Y-shaped trifurcate configuration graft, distributing their bundles in two different areas. Used as measuring instruments, we used the "offset" guides as measuring instruments, allowing the surgeon to know the distance between the centers of the AM and PL tunnels. It may be carried out by means of common "offset" guides and any marketed ASF devices, while generating customized footprints.ClassificationI: knee; II: ACL.

| S-EPMC8417341 | biostudies-literature

Anatomic Double-Bundle Transtibial Anterior Cruciate Ligament Reconstruction.

Project description:Double-bundle anterior cruciate ligament (ACL) reconstruction (DBACLR) is a reasonable transition from single-bundle ACL reconstruction to obtain better clinical outcomes, and most authors believe that it can only be performed through a medial portal. However, in our clinical practice, we have found that anatomic DBACLR can be performed easily and exactly through transtibial tunnels just by positioning the tibial tunnels appropriately. Thus, we would like to introduce this anatomic double-bundle transtibial ACL reconstruction technique, in which the most critical step is to create a shallow tibial tunnel for the anteromedial bundle with a proximal projection to the anatomic location of the corresponding femoral tunnel. We believe this Technical Note will give an interesting view of anatomic DBACLR.

| S-EPMC7953165 | biostudies-literature

TriLink: Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction.

Project description:Cadaveric and clinical biomechanical studies show improved kinematic restoration using double-bundle anterior cruciate ligament (ACL) reconstruction techniques. These have been criticized in the past for being technically challenging. We present a novel 3-socket approach for anatomic "all-inside" double-bundle reconstruction using a single hamstring tendon fashioned to create a trifurcate graft: the TriLink technique. The semitendinosus alone is harvested, quadrupled, and attached to 3 suspensory fixation devices in a Y-shaped configuration, creating a 4-stranded tibial limb and 2 double-stranded femoral limbs. A medial viewing/lateral working arthroscopic approach is adopted using specifically designed instrumentation. Anatomic placement of the 2 femoral tunnels is performed by a validated direct measurement technique. A single mid-bundle position is used on the tibia. Both femoral and tibial sockets are created in a retrograde manner using outside-to-in drilling. This is a simplified operative technique for anatomic double-bundle ACL reconstruction that maximizes bone preservation. The TriLink construct replicates the 2 bundles of the ACL, conferring native functional anisometry and improving femoral footprint coverage while avoiding the complexities and pitfalls of double-tibial tunnel techniques. Preservation of the gracilis reduces the morbidity of hamstring harvest and allows greater flexibility in graft choice in cases requiring multiligament reconstruction.

| S-EPMC3986474 | biostudies-literature

Sandwich-Style Anterior Cruciate Ligament Reconstruction: Double-Bundle Anterior Cruciate Ligament Reconstruction With In-Between Remnant Preservation.

Project description:Various degree of remnant tissues exists following anterior cruciate ligament (ACL) injury. Making use of these tissues may be helpful for the reconstructed ACL from many aspects. There are many methods of remnant preservation and use, as well as many types of combined ACL reconstruction. However, the most effective methods of remnant reuse as well as ACL reconstruction are still being pursued. We introduce an anatomical double-bundle transtibial ACL reconstruction with in-between remnant preservation technique named sandwich-style ACL reconstruction. The indication of this technique is complete ACL tear with a large volume of connectable remnant. The main tricks of this technique are proper ligation of the remnant, proper location of the anteromedial-bundle tibial tunnels, and passing the anteromedial bundle through the shallow side of the remnant. We believe the introduction of this technique will provide more options for remnant preservation and ACL reconstruction.

| S-EPMC8085440 | biostudies-literature

Combined Anatomic Anterior Cruciate Ligament and Double Bundle Anterolateral Ligament Reconstruction.

Project description:The results of arthroscopic anterior cruciate ligament (ACL) reconstruction are so far satisfactory and improving over time as a result of the improved understanding of the anatomy and biomechanics of the ACL. Rotational instability confirmed by a positive pivot shift is present in more than 15% of cases who underwent successful ACL reconstruction. Persistent rotational instability interferes with performing pivoting sports, and also may lead to meniscal and chondral injuries, or re-rupture of the reconstructed ACL. Surgeons reconsidered the anatomy and biomechanics of the ACL and introduced the double bundle ACL reconstruction technique aiming to achieve a more rotational control by reconstructing the anteromedial and anterolateral bundles of the ACL. To date, the results of double bundle ACL reconstruction are mixed and inconsistent. The improved understanding of the existence, function, and biomechanical role of the anterolateral ligament (ALL) in controlling the rotational instability of the knee has redirected and refocused attention on a supplemental extra-articular reconstruction of the ALL in conjunction with the intra-articular ACL reconstruction so as to restore normal kinematics of the knee. In this Technical Note, we describe a technique that allows for a combined ACL and double bundle ALL reconstruction using autogenous hamstring graft (semitendinosus and gracilis) tendons. This technique is an extension of our previously described technique of a combined anatomic ACL and single bundle ALL reconstruction. The improved understanding of the anatomy of the ALL makes a double bundle ALL reconstruction more anatomic than single bundle ALL reconstruction, as the native ALL is triangular or inverted Y in shape, with a narrow proximal femoral attachment and a broad distal tibial attachment between Gerdy's tubercle and the head of the fibula.

| S-EPMC5621982 | biostudies-literature

Kinematic study following double-bundle, anterior cruciate ligament reconstruction.

Project description:The purpose of this study was to evaluate tibiofemoral kinematics after double-bundle anterior cruciate ligament (ACL) reconstructions and compare them with those of successful single-bundle reconstructions and contralateral normal knees using open MR images. We obtained MR images based on the flexion angle without weight-bearing, from 20 patients with successful unilateral single-bundle (10 patients) and double-bundle (10 patients) ACL reconstructions with tibialis anterior allografts and a minimum 1-year follow-up. The MR images of the contralateral uninjured knees were used as normal controls. Sagittal images of the mid-medial and mid-lateral sections of the tibiofemoral compartments were used to measure the translation of the femoral condyles relative to the tibia. The mean translations of the medial femoral condyles on the tibial plateaus during knee joint motion showed no significant differences among normal, single-bundle, and double-bundle ACL reconstructed knees (all p>0.05). The mean translations of the lateral femoral condyles showed a significant difference between normal and single-bundle reconstructed knees, or between single-bundle and double-bundle reconstructed knees (p<0.05). However, there was no significant difference between normal and double-bundle reconstructed knees (p=0.220). These findings suggest that double-bundle ACL reconstruction restores normal kinematic tibiofemoral motion better than single-bundle reconstruction.

| S-EPMC2266641 | biostudies-other

Anatomic Double-Bundle Transtibial Anterior Cruciate Ligament Reconstruction With Ligament Advanced Reinforcement System.

Project description:It has been reported that anterior cruciate ligament reconstruction (ACLR) with the Ligament Advanced Reinforcement System (LARS) could obtain similar clinical outcomes to ACLR with autograft. However, in most related reports, single-bundle ACLR was performed. Given that double-bundle ACLR is more favorable than single-bundle ACLR biomechanically, it is reasonable to try double-bundle ACLR with the LARS clinically. Thus, we introduce an anatomic double-bundle transtibial ACLR technique with the LARS, in which the most critical step is to create a shallow tibial tunnel for the anteromedial bundle to further create the corresponding femoral tunnel in a transtibial manner, as well as to fix both bundles in full extension of the knee.

| S-EPMC11369952 | biostudies-literature

All-Epiphyseal Double-Bundle Anterior Cruciate Ligament Reconstruction for Skeletally Immature Patients.

Project description:The number of anterior cruciate ligament (ACL) reconstructions in skeletally immature patients has been gradually increasing in recent years owing to the poor outcomes of conservative treatment. However, ACL reconstruction in children is a challenging procedure and may lead to severe complications, such as growth disturbance. Although double-bundle (DB) ACL reconstructions are preferable because of their superior clinical outcomes, there are few reports of DB ACL reconstruction in children with open epiphyses. In this Technical Note, an all-epiphyseal sparing DB ACL reconstruction technique, which is considered to help avoid growth disturbance, is described. This procedure does not create a thick tunnel and may facilitate subsequent revision surgery.

| S-EPMC7768289 | biostudies-literature

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