The Journal of Bone and Joint Surgery (American). 2009;91:257-262.
doi:10.2106/JBJS.H.00009
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Anterior Cruciate Ligament Reconstruction with Use of a Single or Double-Bundle Technique in Patients with Generalized Ligamentous Laxity

Sung-Jae Kim, MD1, Ji-Hoon Chang, MD1, Tai-Won Kim, MD1, Seung-Bae Jo, MD1 and Kyung-Soo Oh, MD1

1 Department of Orthopaedic Surgery, Yonsei University College of Medicine, C.P.O. Box 8044, 134, Shinchon-Dong, Seodaemun-Ku, 120-752 Seoul, South Korea. E-mail address for S.-J. Kim: severanscopy{at}yuhs.ac. E-mail address for J.-H. Chang: changjihoon{at}yuhs.ac. E-mail address for T.-W. Kim: dkoshsm{at}yuhs.ac. E-mail address for S.-B. Jo: hanllbit{at}yuhs.ac. E-mail address for K.-S. Oh: orthopaedics11{at}gmail.com

Investigation performed at the Yonsei University Arthroscopy and Joint Research Institute, Yonsei University Health System, Seoul, South Korea

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM/DVD (call our subscription department, at 781-449-9780, to order the CD-ROM or DVD).

Background: In a patient with generalized ligamentous laxity, the risk of instability is greater with a conventionally reconstructed anterior cruciate ligament. The purpose of this study was to compare the clinical outcome of anterior cruciate ligament reconstruction done with a double-bundle technique with use of a quadriceps tendon-bone autograft and that of a single-bundle reconstruction with use of a bone-patellar tendon-bone autograft in patients with generalized ligamentous laxity.

Methods: The records of sixty-one patients who underwent anterior cruciate ligament reconstruction between June 2002 and October 2005 were evaluated. Thirty-two patients underwent a single-bundle reconstruction (group 1), and twenty-nine patients underwent a double-bundle reconstruction (group 2). Clinical outcomes were determined from data obtained before surgery and at the twenty-four-month follow-up visit.

Results: Postoperatively, the mean side-to-side difference (and standard deviation) in anterior tibial translation, measured with use of a KT-2000 arthrometer, was greater for group 1 (3.37 ± 1.76 mm; range, 1.00 to 8.00 mm) than for group 2 (2.03 ± 1.11 mm; range, 0.00 to 3.50 mm) (p = 0.02). Three patients in group 1 had a grade-1+ pivot shift, while no patient in group 2 had an abnormal pivot shift. The mean score on the Hospital for Special Surgery knee ligament questionnaire was 90.8 in group 1 and 92.1 in group 2, and the mean Lysholm score was 89.4 in group 1 and 91.1 in group 2.

Conclusions: On the basis of the evaluation of ligamentous laxity measured by the KT-2000 arthrometer, a double-bundle anterior cruciate ligament reconstruction with use of a quadriceps tendon-bone autograft allows less anterior translation than does a single-bundle reconstruction with use of a bone-patellar tendon-bone autograft. However, we could not identify a significant difference in the functional outcome between the two techniques.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.


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