Double-bundle anatomic ACL-reconstruction with computer assisted surgery: an in-vitro study of the anterior laxity in knees with anatomic double-bundle versus isometric single-bundle reconstruction

摘要

The current standard technique to reconstruct ruptured anterior cruciate ligament (ACL) is through an isometric single-bundle graft. However, the ACL has a two-bundled nature, with the anteromedial bundle (AMB) most tight in flexion and the posterolateral bundle (PLB) near extension. Therefore a double-bundle, anatomically placed, graft is expected to provide better stability over the complete range of motion. The anterior laxity was tested in various flexion angles in knees with anatomic double-bundle and isometric single-bundle reconstruction. Anatomic femoral graft placement was performed using Computer Assisted Surgery (CAS) with the AMB-graft fixated in 90{sup}° of flexion and the PLB in 20{sup}°. Near extension the double-bundle technique caused no significant laxity change compared to a 2.1 mm (34%) increase in single-bundle reconstructed knees. In 90{sup}° of flexion the laxity increase was nearly similar. Over the complete range of motion the anatomic double-bundle technique results in a better functional reconstruction, at the cost of a higher AP-error near extension.