The effect of an Anatomic Double-bundle surgical technique on the outcome of Anterior Cruciate Ligament Reconstructions
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AbstractThe anatomic “Double-bundle” ACL reconstruction technique was developed to improve the outcome of ACL reconstructions. This procedure is both complex, expensive and requires more resources than the traditional "Single-bundle" technique. Cathrine Aga and her co-workers have in the thesis "The effect of an Anatomic Double-bundle surgical technique on the outcome of Anterior Cruciate Ligament Reconstructions" evaluated and compared the two orthopaedic techniques: anatomic Double-bundle versus anatomic Single-bundle for ACL reconstructions. In a randomised controlled trial 62 patients with Single-bundle and 54 patients with a Double-bundle ACL reconstruction were prospectively followed. The aim of the study was to look if there were any difference in the self-reported KOOS Quality of Life, between the two techniques. They found no difference in KOOS QoL subscore or in any other patient related outcome scores between the two groups. Further, they found no difference between the two in knee laxity measures, outcome of functional tests, the activity level or the development of osteoarthritis at 2 years follow up. The Knee Ligament Registers in Norway, Sweden and Denmark were used to analyse the difference in graft-revisions between the same two techniques. Thousand Double-bundles and 52 000 Single-bundle reconstructions were analysed with Cox regression analysis. No difference in the risk of having a graft-revision was found between the two: 3.7 % of the Double-bundles versus 3.8 % of the Single-bundles were revised. This thesis concludes that the anatomic Double-bundle ACL procedure does not contribute to a better subjective, clinical or functional result and does not show a lower risk of revision compared to the anatomic Single-bundle procedure. The Double-bundle technique is both complex and expensive and should therefor not be considered as the method of choice for patients in need of an ACL reconstruction.
List of papers
|Paper I: C Aga, MA Risberg, M Fagerland, S Johansen, S Heir, I Trøan, L Engebretsen. No difference in the KOOS Quality of Life between anatomic Double-bundle and anatomic Single-bundle Anterior Cruciate Ligament reconstruction of the knee; a Prospective, Randomised, Controlled Trial. American Journal of Sports Medicine, 2018, 46, 2341-2354. doi: 10.1177/0363546518782454. The accepted paper is included in the thesis. The published version is available at https://doi.org/10.1177/0363546518782454|
|Paper II: C Aga, JT Kartus, M Lind, SH Låstad Lygre, LP Granan, L Engebretsen. Risk of Revision Was Not Reduced by a Double-bundle ACL Reconstruction Technique: Results From the Scandinavian Registers. Clin Orthop Relat Res. 2017 Oct;475(10):2503-2512. doi:10.1007/s11999-017-5409-3. The paper is not available in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1007/s11999-017-5409-3|
|Paper III: C Aga, M T Rasmussen, SD Smith, KD Jansson, RF LaPrade, L Engebretsen, CA Wijdicks. Biomechanical comparison of Interference screws and Combination screw and sheath devices for soft tissue Anterior Cruciate Ligament reconstruction on the tibial side. The American Journal of Sports Medicine. 2013 Apr;41(4):841-8. doi: 10.1177/0363546512474968. The article is included in the thesis. Also available at: https://doi.org/10.1177/0363546512474968|
|Paper IV: C Aga, KJ Wilson, S Johansen, G Dornan, RF LaPrade, L Engebretsen. Tunnel widening in singleversus double-bundle anterior cruciate ligament reconstructed knees. Knee Surg Sports Traumatol Arthrosc. 2017 Apr;25(4):1316-1327. doi: 10.1007/s00167-016-4204-0. The paper is not available in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1007/s00167-016-4204-0|