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J Knee Surg 2021; 34(14): 1545-1554
DOI: 10.1055/s-0040-1710376
Original Article

Clinical and Radiographic Outcomes of Double-Bundle Anterior Cruciate Ligament Reconstruction for Asian Patients with Bone-Patellar Tendon-Bone and Gracilis Tendon Grafts: A Matched-Control Comparison

Takuya Tajima
1   Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
,
Nami Yamaguchi
1   Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
,
Yudai Morita
1   Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
,
Makoto Nagasawa
1   Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
,
Tomomi Ota
1   Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
,
Yoshihiro Nakamura
1   Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
,
Takuji Yokoe
1   Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
,
Etsuo Chosa
1   Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Abstract

For anterior cruciate ligament (ACL)-deficient patients, using a single bone-patellar tendon-bone (BPTB) graft for the double-bundle concept is one of the suitable approaches for acquiring better stability and reducing bone tunnel enlargement compared with the use of hamstring grafts. At least 10-mm width of BPTB autograft is needed to achieve this concept; however, it is larger than one-third of the patellar tendon width for small or middle physique patients. This study aimed to assess the clinical and radiographic outcomes of BPTB and gracilis (G) composite autografts for primary double-bundle ACL reconstruction in Asian athletes. Thirty-two Asian patients undergoing double-bundle ACL reconstruction with 7.0 to 7.5 mm of BPTB and 5.0 to 5.5 mm of G composite grafts were compared with 43 double-bundle ACL reconstruction with hamstring graft cases. The BPTB graft was used for the anteromedial bundle (AMB), with the G graft for the posterolateral bundle (PLB). Percentage of femoral bone tunnel enlargement compared with the original size was determined by computed digital radiographs on the first postoperative day and at 12 months in the anteroposterior (AP) and lateral views. Standard clinical evaluations, including the limb symmetry index (LSI), were also performed. Less PLB tunnel enlargement was found in the BPTB + G group than in the hamstring group in the AP (101.9 ± 22.9 vs.113.7 ± 20.6%, p = 0.031) and lateral views (104.4 ± 18.1 vs. 120.6 ± 23.4%, p < 0.01).There was no significant difference between the groups in 12-month postoperative clinical outcomes (Lysholm's score, Tegner's activity level scale, and International Knee Documentation Committee subjective knee evaluation score).The side-to-side difference was significantly less in the BPTB + G group (0.2 ± 1.3 vs. 0.9 ± 1.1 mm, p = 0.026). Despite the small sizes of the BPTB and G grafts, there was no significant difference in the knee extensor LSI between the groups (92.9 ± 10.1 vs. 93.3 ± 12.2%, p = 0.707), whereas the knee flexor LSI was significantly higher in the BPTB + G group (97.7 ± 14.8 vs. 90.1 ± 13.3%, p = 0.033). Double-bundle ACL reconstruction with a small size BPTB and G composite graft procedure provided good clinical outcomes and significantly less femoral bone tunnel enlargement than the hamstring procedure 12 months after surgery. It is thus a useful surgical option for ACL-deficient Asian athletes. This study reflects level of evidence III.

Keywords

anterior cruciate ligament - double-bundle reconstruction - bone-patellar tendon-bone graft - gracilis tendon graft - tunnel enlargement


Publikationsverlauf

Eingereicht: 12. November 2019

Angenommen: 21. März 2020

Artikel online veröffentlicht:
19. Mai 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Yasuda K, Tanabe Y, Kondo E, Kitamura N, Tohyama H. Anatomic double-bundle anterior cruciate ligament reconstruction: Current concepts. Arthroscopy 2010; 26: 212-234
    CrossrefPubMedSuche in Google Scholar
  • 2 Miller SL, Gladstone JN. Graft selection in anterior cruciate ligament reconstruction. Orthop Clin North Am 2002; 33 (04) 675-683
    CrossrefPubMedSuche in Google Scholar
  • 3 Pujol N, Fong O, Karoubi M, Beaufils P, Boisrenoult P. Anatomic double-bundle ACL reconstruction using a bone-patellar tendon-bone autograft: a technical note. Knee Surg Sports Traumatol Arthrosc 2010; 18 (01) 43-46
    CrossrefPubMedSuche in Google Scholar
  • 4 Shino K, Nakata K, Nakamura N. et al. Rectangular tunnel double-bundle anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft to mimic natural fiber arrangement. Arthroscopy 2008; 24 (10) 1178-1183
    CrossrefPubMedSuche in Google Scholar
  • 5 Yasuda K, Kondo E, Ichiyama H, Tanabe Y, Tohyama H. Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: comparisons among 3 different procedures. Arthroscopy 2006; 22 (03) 240-251
    CrossrefPubMedSuche in Google Scholar
  • 6 Clatworthy MG, Annear P, Bulow JU, Bartlett RJ. Tunnel widening in anterior cruciate ligament reconstruction: a prospective evaluation of hamstring and patella tendon grafts. Knee Surg Sports Traumatol Arthrosc 1999; 7 (03) 138-145
    CrossrefPubMedSuche in Google Scholar
  • 7 Freedman KB, D'Amato MJ, Nedeff DD, Kaz A, Bach Jr BR. Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med 2003; 31 (01) 2-11
    CrossrefPubMedSuche in Google Scholar
  • 8 Tachibana Y, Mae T, Shino K. et al. Femoral tunnel enlargement after anatomic anterior cruciate ligament reconstruction: Bone-patellar tendon-bone/single rectangular tunnel versus hamstring tendon/double tunnels. J Orthop Sci 2018; 23 (06) 1011-1018
    CrossrefPubMedSuche in Google Scholar
  • 9 Hiemstra LA, Webber S, MacDonald PB, Kriellaars DJ. Knee strength deficits after hamstring tendon and patellar tendon anterior cruciate ligament reconstruction. Med Sci Sports Exerc 2000; 32 (08) 1472-1479
    CrossrefPubMedSuche in Google Scholar
  • 10 Kartus J, Movin T, Karlsson J. Donor-site morbidity and anterior knee problems after anterior cruciate ligament reconstruction using autografts. Arthroscopy 2001; 17 (09) 971-980
    CrossrefPubMedSuche in Google Scholar
  • 11 Niki Y, Matsumoto H, Hakozaki A, Kanagawa H, Toyama Y, Suda Y. Anatomic double-bundle anterior cruciate ligament reconstruction using bone-patellar tendon-bone and gracilis tendon graft: a comparative study with 2-year follow-up results of semitendinosus tendon grafts alone or semitendinosus-gracilis tendon grafts. Arthroscopy 2011; 27 (09) 1242-1251
    CrossrefPubMedSuche in Google Scholar
  • 12 Petsche TS, Hutchinson MR. Loss of extension after reconstruction of the anterior cruciate ligament. J Am Acad Orthop Surg 1999; 7 (02) 119-127
    CrossrefPubMedSuche in Google Scholar
  • 13 Achtnich A, Stiepani H, Forkel P, Metzlaff S, Hänninen EL, Petersen W. Tunnel widening after anatomic double-bundle and mid-position single-bundle anterior cruciate ligament reconstruction. Arthroscopy 2013; 29 (09) 1514-1524
    CrossrefPubMedSuche in Google Scholar
  • 14 Järvelä T, Moisala AS, Paakkala T, Paakkala A. Tunnel enlargement after double-bundle anterior cruciate ligament reconstruction: a prospective, randomized study. Arthroscopy 2008; 24 (12) 1349-1357
    CrossrefPubMedSuche in Google Scholar
  • 15 Siebold R, Cafaltzis K. Differentiation between intraoperative and postoperative bone tunnel widening and communication in double-bundle anterior cruciate ligament reconstruction: a prospective study. Arthroscopy 2010; 26 (08) 1066-1073
    CrossrefPubMedSuche in Google Scholar
  • 16 Silva A, Sampaio R, Pinto E. Femoral tunnel enlargement after anatomic ACL reconstruction: a biological problem?. Knee Surg Sports Traumatol Arthrosc 2010; 18 (09) 1189-1194
    CrossrefPubMedSuche in Google Scholar
  • 17 Gifstad T, Foss OA, Engebretsen L. et al. Lower risk of revision with patellar tendon autografts compared with hamstring autografts: a registry study based on 45,998 primary ACL reconstructions in Scandinavia. Am J Sports Med 2014; 42 (10) 2319-2328
    CrossrefPubMedSuche in Google Scholar
  • 18 Samuelsen BT, Webster KE, Johnson NR, Hewett TE, Krych AJ. Hamstring autograft versus patellar tendon autograft for ACL reconstruction: Is there a difference in graft failure rate? A meta-analysis of 47,613 patients. Clin Orthop Relat Res 2017; 475 (10) 2459-2468
    CrossrefPubMedSuche in Google Scholar
  • 19 Bedi A, Musahl V, O'Loughlin P. et al. A comparison of the effect of central anatomical single-bundle anterior cruciate ligament reconstruction and double-bundle anterior cruciate ligament reconstruction on pivot-shift kinematics. Am J Sports Med 2010; 38 (09) 1788-1794
    CrossrefPubMedSuche in Google Scholar
  • 20 Siebold R, Dehler C, Ellert T. Prospective randomized comparison of double-bundle versus single-bundle anterior cruciate ligament reconstruction. Arthroscopy 2008; 24 (02) 137-145
    CrossrefPubMedSuche in Google Scholar
  • 21 Dejour D, Ferrua P, Bonin N, Saggin PRF. Double-bundle bone-patellar tendon-bone and gracilis in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2012; 20 (11) 2239-2242
    CrossrefPubMedSuche in Google Scholar
  • 22 Jung KA, Lee SC, Song MB, Lee CK. Arthroscopic double bundle ACL reconstruction using a bone patellar tendon bone-gracilis tendon composite autograft: a technical note. Knee Surg Sports Traumatol Arthrosc 2008; 16 (04) 382-385
    CrossrefPubMedSuche in Google Scholar
  • 23 Yoo JH, Yi SR, Kim JH. The geometry of patella and patellar tendon measured on knee MRI. Surg Radiol Anat 2007; 29 (08) 623-628
    CrossrefPubMedSuche in Google Scholar
  • 24 Oikawa R, Tajima G, Yan J. et al. Morphology of the patellar tendon and its insertion sites using three-dimensional computed tomography: A cadaveric study. Knee 2019; 26 (02) 302-309
    CrossrefPubMedSuche in Google Scholar
  • 25 Svensson M, Kartus J, Ejerhed L, Lindahl S, Karlsson J. Does the patellar tendon normalize after harvesting its central third?: a prospective long-term MRI study. Am J Sports Med 2004; 32 (01) 34-38
    CrossrefPubMedSuche in Google Scholar
  • 26 Milankov M, Kecojević V, Rasović P, Kovacević N, Gvozdenović N, Obradović M. Disruption of the knee extensor apparatus complicating anterior cruciate ligament reconstruction. Acta Chir Iugosl 2013; 60 (02) 13-21
    CrossrefPubMedSuche in Google Scholar
  • 27 Lairungruang W, Kuptniratsaikul S, Itiravivong P. The remained patellar tendon strength after central one third removal : a biomechanical study. J Med Assoc Thai 2003; 86 (12) 1101-1105
    PubMedSuche in Google Scholar
  • 28 Tajima T, Chosa E, Kawahara K, Yamaguchi N. Prospective comparisons of femoral tunnel enlargement with 3 different postoperative immobilization periods after double-bundle anterior cruciate ligament reconstruction with hamstring grafts. Arthroscopy 2015; 31 (04) 651-658
    CrossrefPubMedSuche in Google Scholar
  • 29 Tajima T, Chosa E, Yamamoto K, Yamaguchi N. Arthroscopic anatomical double-bundle anterior cruciate ligament reconstruction for asian patient using a bone-patellar tendon-bone and gracilis tendon composite autograft: a technical note. Sports Med Arthrosc Rehabil Ther Technol 2012; 4 (01) 9
    CrossrefPubMedSuche in Google Scholar
  • 30 Hara K, Kubo T, Suginoshita T, Shimizu C, Hirasawa Y. Reconstruction of the anterior cruciate ligament using a double bundle. Arthroscopy 2000; 16 (08) 860-864
    CrossrefPubMedSuche in Google Scholar
  • 31 Kawaguchi Y, Kondo E, Kitamura N, Kai S, Inoue M, Yasuda K. Comparisons of femoral tunnel enlargement in 169 patients between single-bundle and anatomic double-bundle anterior cruciate ligament reconstructions with hamstring tendon grafts. Knee Surg Sports Traumatol Arthrosc 2011; 19 (08) 1249-1257
    CrossrefPubMedSuche in Google Scholar
  • 32 Webster KE, Feller JA, Hameister KA. Bone tunnel enlargement following anterior cruciate ligament reconstruction: a randomised comparison of hamstring and patellar tendon grafts with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 2001; 9 (02) 86-91
    CrossrefPubMedSuche in Google Scholar
  • 33 Sharkey NA, Donahue SW, Smith TS, Bay BK, Marder RA. Patellar strain and patellofemoral contact after bone-patellar tendon-bone harvest for anterior cruciate ligament reconstruction. Arch Phys Med Rehabil 1997; 78 (03) 256-263
    CrossrefPubMedSuche in Google Scholar
  • 34 Tsuda E, Okamura Y, Ishibashi Y, Otsuka H, Toh S. Techniques for reducing anterior knee symptoms after anterior cruciate ligament reconstruction using a bone-patellar tendon-bone autograft. Am J Sports Med 2001; 29 (04) 450-456
    CrossrefPubMedSuche in Google Scholar
  • 35 Zysk SP, Fraunberger P, Veihelmann A. et al. Tunnel enlargement and changes in synovial fluid cytokine profile following anterior cruciate ligament reconstruction with patellar tendon and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc 2004; 12 (02) 98-103
    CrossrefPubMedSuche in Google Scholar
  • 36 Naraoka T, Kimura Y, Tsuda E, Yamamoto Y, Ishibashi Y. Does remnant preservation influence tibial tunnel enlargement or graft-to-bone integration after double-bundle anterior cruciate ligament reconstruction using hamstring autografts and suspensory fixation? A computed tomography and magnetic resonance imaging evaluation. Orthop J Sports Med 2018;6(08): 2325967118790238
    PubMed
  • 37 Webster KE, Feller JA, Elliott J, Hutchison A, Payne R. A comparison of bone tunnel measurements made using computed tomography and digital plain radiography after anterior cruciate ligament reconstruction. Arthroscopy 2004; 20 (09) 946-950
    CrossrefPubMedSuche in Google Scholar