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Single-bundle patellar tendon versus non-anatomical double-bundle hamstrings ACL reconstruction: a prospective randomized study at 8-year minimum follow-up

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to compare subjective, objective and radiographic outcome of the lateralized single-bundle bone-patellar tendon-bone autograft with a non-anatomical double-bundle hamstring tendons autograft anterior cruciate ligament (ACL) reconstruction technique at long-term follow-up.

Methods

Seventy-nine non-consecutive randomized patients (42 men; 37 women) with unilateral ACL insufficiency were prospectively evaluated, before and after ACL reconstruction by means of the above-mentioned techniques, with a minimum follow-up of 8 years (range 8–10 years; mean 8.6 years). In the double-bundle hamstrings technique, we used one tibial and one femoral tunnel combined with one “over-the-top” passage, cortical staple’s fixation and we left intact hamstrings’ tibial insertion. Patients were evaluated subjectively and objectively, using IKDC score, Tegner level, manual maximum displacement test with KT-2000™ arthrometer. Radiographic evaluation was performed according to IKDC grading system, and re-intervention rate for meniscal lesions was also recorded.

Results

The subjective and objective IKDC were similar in both groups while double-bundle hamstrings group showed significantly higher Tegner level (P = 0.0007), higher passive range of motion recovery (P = 0.0014), faster sport resumption (P = 0.0052), lower glide pivot-shift phenomenon (P = 0.0302) and lower re-intervention rate (P = 0.0116) compared with patellar tendon group. Radiographic evaluation showed significant lower objective degenerative changes in double-bundle hamstrings group at final follow-up (P = 0.0056).

Conclusion

Although both techniques provide satisfactory results, double-bundle ACL reconstruction shows better functional results, with a faster return to sport activity, a lower re-operation rate and lower degenerative knee changes.

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Acknowledgments

The authors would like to acknowledge Mrs. Silvia Bassini for preparing technique’s illustrations; Giovanni Giordano, MD, Marco Nitri, MD, Cecilia Signorelli, Eng and the Library Staff of Istituti Ortopedici Rizzoli for their technical support.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. 3rd Orthopaedic and Traumatology Clinic, Rizzoli Orthopaedic Institute, Bologna University, Bologna, Italy

    Stefano Zaffagnini, Danilo Bruni, Giulio Maria Marcheggiani Muccioli, Tommaso Bonanzinga, Nicola Lopomo, Simone Bignozzi & Maurilio Marcacci

  2. Biomechanics and Technology Innovation Laboratory, Codivilla-Putti Research Center, Rizzoli Orthopaedic Institute, Bologna University, Bologna, Italy

    Stefano Zaffagnini, Danilo Bruni, Giulio Maria Marcheggiani Muccioli, Tommaso Bonanzinga, Nicola Lopomo, Simone Bignozzi & Maurilio Marcacci

  3. Laboratorio di Biomeccanica, Istituti Ortopedici Rizzoli, via di Barbiano, 1/10, 40100, Bologna, Italy

    Stefano Zaffagnini

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  1. Stefano Zaffagnini
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  2. Danilo Bruni
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  7. Maurilio Marcacci
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Correspondence to Stefano Zaffagnini.

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Zaffagnini, S., Bruni, D., Marcheggiani Muccioli, G.M. et al. Single-bundle patellar tendon versus non-anatomical double-bundle hamstrings ACL reconstruction: a prospective randomized study at 8-year minimum follow-up. Knee Surg Sports Traumatol Arthrosc 19, 390–397 (2011). https://doi.org/10.1007/s00167-010-1225-y

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