Double-bundle anterior cruciate ligament reconstruction

Autor: M. E. Del Valle, Ana Isabel Fente Alvarez, A. Meana, E. Suárez, Cristina Rodríguez, Alicia Maestro, P. García, L. Rodríguez
Rok vydání: 2009
Předmět:
Zdroj: Revista Española de Cirugía Ortopédica y Traumatología (English Edition). 53:13-19
ISSN: 1988-8856
DOI: 10.1016/s1988-8856(09)70135-x
Popis: Purpose To design a technique aimed at reducing the incidence of residual laxity in anterior cruciate ligament (ACL) surgery. Materials and methods An anatomic study was performed in 20 cadaver knees and in 50 human femurs and 50 human tibias. In addition, a mechanical study was made of the consequences of sectioning the bundles in the cadaver knee. Results The ACL presented with a tibial piriformis attachment, with an oblique greater axis and an area of 15.8?11.6mm. The femoral attachment was egg-shaped (15?8mm) with a 15-30° inclination with respect to the posterior cortex. The length of the anteromedial (AM) bundle was 34±4,5mm and of the posterolateral (PL) bundle 22±4mm. The double-bundle technique caused 32.8% more bone resection than the single tunnel technique, but resulted in 62.5% less stress on the fixation system; maximum load to failure was 785N. On being sectioned, both bundles showed, at neutral rotation and 30° flexion, identical behaviors. The greatest strains were withstood by the AM bundle when the knee was at 95° flexion and neutral rotation, and by the PL bundle when the knee was in extension and external rotation. Conclusions Reproducing the double-bundle morphology of the ACL is a successful method that is well-adapted to the anatomy and biomechanics of the ACL and that can be carried out through a single tibial tunnel.
Databáze: OpenAIRE
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