PURPOSE OF THE STUDY Knee injuries accompanied by anterior cruciate ligament (ACL) tears can also result in rotational instability of the joint. Subsequent insufficient rotational stability after the ACL reconstruction can be a direct consequence also of injuries to lateral knee structures, specifically the anterolateral ligament (ALL). This residual postoperative rotational instability may be prevented by multiple surgical techniques. The purpose of this study was (1) to evaluate the knee stability in internal rotation after the "anatomical" single-bundle (SB) anterior cruciate ligament reconstruction together with ALL reconstruction compared to the double-bundle (DB) ACL reconstruction two years after surgery; (2) to compare the knee joint stability after the ACL and ALL reconstruction with the healthy contralateral knee joint. MATERIAL AND METHODS All the measurements were conducted by the computer navigation system. The study included 20 patients after the single-bundle ACL and ALL reconstruction and 20 patients after the double-bundle ACL reconstruction. The follow-up examination was carried out at 25 months after surgery on average (24 months at least). All measurements were performed in both the healthy and operated knee. Once the data necessary for navigation were determined, the patient remained in standing position with both feet firmly placed on the mat with intermalleolar distance of 20 cm. Then, at 30-degree flexion of the knee joints, the patient first performed the joint internal rotation by trunk torsion, followed by external rotation. Each measurement was repeated 3 times. A non-parametric t-test was used for statistical processing. RESULTS The mean internal rotation in the injured knee joint was 19.1 degrees preoperatively and 8.1 degrees postoperatively, while in the healthy knee it was 8.4 degrees. External rotation was not assessed. The reported internal rotation in the knees after DB ACL reconstruction was 9.2 degrees (p ≥ 0.05). DISCUSSION The double-bundle ACL reconstruction is a complex technique that can lead to many intraoperative and postoperative complications. Grafts harvested from both hamstrings can have an effect on the rotational stability of the joint. In order to restore the knee rotational stability with fewer potential complications, the method of choice can be the ACL reconstruction using the quadriceps femoris muscle graft and the ALL reconstruction using the gracilis muscle graft, leaving the semitendinosus tendon intact. CONCLUSIONS The obtained values reveal that the single-bundle ACL reconstruction in combination with ALL reconstruction results in the same internal rotational stability in the knee joint as the double-bundle ACL reconstruction. Similar joint rotational stability is observed in all the knee joints reconstructed with the use of these techniques and in the contralateral healthy knee joint. Key words: anterolateral ligament, anterior cruciate ligament, internal rotational stability, objective measurement.

• MeSH
• Biomechanical Phenomena MeSH
• Knee Joint surgery   MeSH
• Humans MeSH
• Cadaver MeSH
• Joint Instability * etiology   surgery   MeSH
• Anterior Cruciate Ligament Injuries * surgery   MeSH
• Anterior Cruciate Ligament Reconstruction * MeSH
• Range of Motion, Articular MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

• MeSH
• Musculoskeletal System surgery   pathology   MeSH
• Orthopedic Procedures MeSH
• Athletic Injuries surgery   MeSH

• Conspectus
• Ortopedie. Chirurgie. Oftalmologie
• NML Fields
• ortopedie
• chirurgie
• tělovýchovné lékařství
• NML Publication type
• kolektivní monografie

PURPOSE: The objective of this study was to evaluate knee rotational stability at least 2 years after anatomic single-bundle anterior cruciate ligament (ACL) reconstruction (SB) and double-bundle ACL reconstruction (DB) in comparison with the contralateral healthy knee joint. The Cincinnati, Lysholm and IKDC scores were analysed too. METHODS: There were 40 patients in both groups, the mean follow-up was 27 months. For all measurements, the navigation system OrthoPilot was used. Measurement started with the patient in the standing position in neutral rotation. Then, the patient achieved in 30° knee flexion under weight-bearing maximal external trunk rotation and returned to the neutral position. The same measurement was done for the internal trunk rotation. For the anterior-posterior stability, KT-1000 arthrometer was used. All measurements were repeated three times for each knee joint. RESULTS: After the DB reconstruction, the mean external rotation of the tibia (ER) was 8.2° and the internal rotation (IR) was 10.2°. In the contralateral healthy knee joint, ER was 8.5° (p = 0.597) and IR was 12.1° (p = 0.064). After the SB reconstruction, ER was 9.4° and IR was 13.1°. In the contralateral healthy knee joint, ER was 7.7° (p = 0.066) and IR was 9.8° (p = 0.005). Anterior-posterior translation was to the same extent for both groups. CONCLUSIONS: The DB reconstruction of the ACL restores the rotational stability of the knee joint without any significant difference in comparison to the contralateral healthy knee (p > 0.05). The main finding of this study is that the internal rotational stability of the knee joint after the anatomic SB technique is not sufficient.

• MeSH
• Biomechanical Phenomena MeSH
• Adult MeSH
• Knee Joint physiopathology   surgery   MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Follow-Up Studies MeSH
• Joint Instability physiopathology   surgery   MeSH
• Anterior Cruciate Ligament Injuries physiopathology   surgery   MeSH
• Anterior Cruciate Ligament Reconstruction * MeSH
• Rotation MeSH
• Range of Motion, Articular physiology   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

PURPOSE OF THE STUDY: The aim of the study is to present a comparison of short-term results of double- versus single-bundle anatomical reconstruction of the anterior cruciate ligament (ACL) using hamstring endons and their fixation with absorbable interference screws. MATERIAL AND METHODS: A total of 110 patients with an isolated ACL lesion and the healthy contralateral knee who met the indication criteria for ACL double bundle reconstruction (TISL, 14 mm; ICNW, 12 mm) were intra-operatively allocated at random to either double-bundle group (DB, n=55) or single-bundle group (SB, n=55). At 12 months after surgery, 97 patients (DB group, n=49; SB group, n=48), comprising 68 men and 29 women, were evaluated; the average age was 29.1 years and the injury-to-surgery interval was 15.9 weeks. Pre- and post-operative subjective criteria involved the IKDC and Lysholm score. Objectively, the occurrence of graft failure, range of motion deficit, return to pre-injury sports activity, side-to-side difference in anterior laxity of both knees in 20° flexion on a GNRB laximeter at an applied pressure of 124 N and 250 N, and pivot shift phenomenon were assessed. RESULTS: No statistically significant difference was found in pre-operative values between the two groups. Post-operatively, there were no significant differences in the occurrence of complete graft failure (p=0.0755; DB group, n=0; SB group, n=3), range-of-motion deficit (p=0.2277-0.9788) or return to pre-operative sports activity (p=0.2322). In the DB group, side-to-side anterior tibial shifts at a pressure of 124 N (medians=1.3 mm and 2.1 mm for DB and SB groups, respectively; p=0.0007) and at a pressure of 250 N (DB group =2.1 mm; SB group = 3.1 mm; p<0.0001) were significantly different from the corresponding values in the SB group. Positive results for the pivot shift test (PST) were significantly less frequent in the DB than the SB group (Chi-square test =0.0112). The SB group patients had a 2.9-times (odds ratio, 2.8704) higher risk of positive postoperative PST results than the DB group patients. In both groups, a comparison of pre- and post-operative criteria showed significant improvement in both the subjective and the objective results. DISCUSSION: The results of this study, in accordance with other authors' conclusions, suggest that the double-bundle technique provides better control over rotational and anterior knee laxity and therefore restores knee biomechanics better. However, other literature data do not confirm any significantly better outcomes of this method. Since only short-term results have been obtained so far, the study will continue because only the long-term results can provide conclusive evidence of an advantage of one technique over the other. CONCLUSIONS: Our study showed significantly better restoration of knee rotational and anterior laxity in the patients undergoing anatomical reconstruction of the ACL by the double-bundle technique. The other evaluated criteria did not differ in relation to the technique used.

• MeSH
• Biomechanical Phenomena MeSH
• Adult MeSH
• Knee Joint surgery   MeSH
• Humans MeSH
• Anterior Cruciate Ligament MeSH
• Joint Instability * diagnosis   etiology   MeSH
• Postoperative Complications diagnosis   MeSH
• Anterior Cruciate Ligament Injuries MeSH
• Anterior Cruciate Ligament Reconstruction * adverse effects   instrumentation   methods   MeSH
• Range of Motion, Articular MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• English Abstract MeSH
• Journal Article MeSH
• Randomized Controlled Trial MeSH

PURPOSE OF THE STUDY A comparison of the efficacy of central anatomical single-bundle (CASB) reconstruction with that of double-bundle (DB) repair of the anterior cruciate ligament (ACL) in relation to knee stability in anteroposterior translation (APT), internal rotation (IR) and external rotation (ER) of the joint. MATERIAL AND METHODS A total of 40 patients were evaluated; 20 had ACL reconstruction by the CASB technique using hamstrings and 20 underwent DB repair surgery. The average age was 31.3 years, and the group included 22 men and 18 women with 19 right and 21 left knees. The KT-1000 test was used to assess the amount of APT in the knee and rotational deviations were measured by the Rolimeter. In the DB patients, measurements were performed before surgery (on joints with ACL injury), then after reconstruction of the anteromedial (AM) or the posterolateral (PL) bundle and subsequently after repair of both ACL bundles. The CASB patients were assessed before and after graft insertion. RESULTS The average APT value was 18.5 mm for the pre-operative knees and it fell to 8.9 mm after AM bundle reconstruction. However, when the PL bundle was inserted in the first place, the average APT value was 13.1 mm only. The average values recorded after the DB and CASB reconstructions were 6.1 mm and 9.1 mm, respectively. The average IR range of motion in the pre-operative joints was 18.6 degrees. After AM bundle reconstruction it was 13.9 degrees and after PL bundle repair it was 15.3 degrees. In DB reconstruction the average IR value achieved 10.4 degrees, and in CASB repair surgery it was 13.7 degrees. The average ER range of motion in the pre-operative joints was 17.8 degrees. After AM bundle reconstruction it was 14.5 degrees and after PL bundle repair it was 14.9 degrees. In DB reconstruction the average ER value achieved 11.4 degrees, and in CASB repair surgery it was 14.5 degrees. DISCUSSION Rotational stability of the knee after ACL reconstruction is one of the most important factors in restoring physiological kinematics of the joint after ACL injury. Since there are not many studies comparing knee rotational stability after CASB with that after DB reconstructions, the results presented here may contribute to selecting the optimal method of ACL reconstruction. CONCLUSIONS The results show that, in ACL reconstruction, the DB technique provides better stability to the knee, in both APT and rotation, than the CASB method. The latter has the same effect on knee stability as the presence of the AM bundle alone. When the PL bundle is added, knee stability, in both APT and internal/external rotation, is increased in comparison with central single-bundle ACL repair. Key words:anterior cruciate ligament, navigation, central anatomical single-bundle reconstruction, double-bundle reconstruction.

• MeSH
• Surgery, Computer-Assisted MeSH
• Adult MeSH
• Knee Joint physiopathology   MeSH
• Humans MeSH
• Anterior Cruciate Ligament pathology   surgery   MeSH
• Adolescent MeSH
• Young Adult MeSH
• Joint Instability etiology   pathology   physiopathology   surgery   MeSH
• Knee Injuries complications   surgery   MeSH
• Anterior Cruciate Ligament Injuries MeSH
• Anterior Cruciate Ligament Reconstruction methods   MeSH
• Range of Motion, Articular MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• English Abstract MeSH
• Journal Article MeSH
• Clinical Trial MeSH
• Comparative Study MeSH

PURPOSE OF THE STUDY The aim of the study was to compare two options of how to get the correct anatomical position of both femoral tunnels, using the transtibial or the anteromedial portal technique, during anatomical double-bundle anterior cruciate ligament (ACL) reconstruction. MATERIAL AND METHODS A total of 36 patients, 29 men and seven women, underwent double-bundle ACL reconstruction between October 2009 and December 2010. Their average age was 26.5 years. The average interval between ACL injury and reconstruction was 7.4 months. A diagnostic arthroscopy for the treatment of cartilage and meniscal lesions was performed in 21 patients and one-stage ACL reconstruction with diagnostic arthroscopy was carried out in the remaining 15 patients. In all 36 patients, the position of the tip of the guide wire in relation to the anatomical insertion sites of both the anteromedial (AM) and posterolateral (PL) bundles was assessed intra-operatively. Three guide wire positions were found: the tip was in the centre of the native insertion site, the tip was within the insertion site but not in its centre, and the tip was outside the insertion site. RESULTS Using the transtibial technique through the AM tunnels, the tip of the guide wire was centred within the femoral AM insertion site only in one patient (2.8%), out of the centre but within the AM insertion site in four patients (11.1%) and outside the insertion site in the remaining 31 patients (86.1%). With this technique, the position of the femoral PL tunnels was outside the native PL insertion site in all 36 patients. With the transtibial technique using the PL tunnels, the tip of the guide wire was centred within the femoral AM native insertion in 11 patients (30.5%), out of the centre but still within the AM insertion site in 16 (44.5%) and outside the AM insertion site in nine patients (25%). Aiming for the femoral PL tunnel resulted in the tip of the guide wire being outside the native femoral PL insertion site in all cases. Using the technique of guide wire insertion through an accessory AM portal it was possible to achieve the centres of both the AM and PL native anatomical insertion sites in all 36 patients (100%). DISCUSSION We agree with the many authors who recommend the reaming of PL femoral tunnels through an accessory AM portal because the transtibial technique does not allow for the placement of their precise native anatomical positions. Our intra-operative findings showed that the transtibial technique was effective to get the correct anatomical position of AM femoral tunnels just in 30.5% of the patients. In view of the fact that the same results can be achieved with the AM transportal technique in 100% of the patients, we prefer this technique in accordance with the majority of other authors. CONCLUSIONS In anatomical double-bundle ACL reconstruction, the native anatomical position of PL tunnels was achieved in all patients and the native AM tunnels in most of them using the accessory AM portal technique. The transtibial technique proved to be unsatisfactory.

• MeSH
• Arthroscopy methods   MeSH
• Adult MeSH
• Humans MeSH
• Anterior Cruciate Ligament anatomy & histology   surgery   MeSH
• Adolescent MeSH
• Young Adult MeSH
• Recovery of Function MeSH
• Orthopedic Procedures methods   MeSH
• Knee Injuries surgery   MeSH
• Anterior Cruciate Ligament Injuries MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH

PURPOSE OF THE STUDY The aim of this prospective study was to evaluate functional outcomes and knee joint stability after double-bundle anterior cruciate ligament reconstruction using three-tunnel quadriceps tendon-bone graft and four-tunnel hamstring graft (semi-tendinosus and gracilis muscles). MATERIAL Group 1 included 20 patients undergoing reconstruction with quadriceps tendon- bone graft group; 2 comprised of 20 patients treated by hamstring graft. There were 26 men and 14 women, with an average age of 27 (range, 16 to 44) years. The minimum follow-up period was one year. METHODS In group 1 patients, semi-anatomic anterior cruciate ligament reconstruction was performed by a three-tunnel technique (two tunnels in the femur and one in the tibia) using quadriceps femoris muscle graft. Group 2 patients were treated by anatomic four-tunnel reconstruction (two tunnels in the femur and two in the tibia) with the use of hamstring graft. Functional outcomes were evaluated on the basis of Lysholm and IKDC scores. Antero-posterior stability was measured with a KT-1000 arthrometer and rotational stability was assessed by the pivot-shift test. For statistical evaluation, the level of significance (p) was set at < 0.05. RESULTS The final evaluation showed an average Lysholm score of 88.9 + 12 (76-100) points for group 1, and 87.9 + 11 (62-100) points for group 2; there was no statistically significant difference. The rounded average result of the functional IKDC score after surgery was the same in the two groups (80 +10). The joints treated by the three-tunnel technique had on average better antero-posterior stability, but this was not statistically significant. The pivot-shift phenomenon was not seen in either of the groups. Operative times in both groups were comparable. An intra-operative fracture of the patella occurred in two patients of group 1. DISCUSSION No similar prospective study comparing the outcomes of the methods reported here has been found in the international literature. The studies so far published have not included any such comparison or they compared other techniques, such as single- versus double-bundle reconstructions. CONCLUSIONS Based on Lysholm and IKDC score evaluation and antero-posterior and rotational stability assessment, it can be concluded that both the three- and the four-tunnel technique of anterior cruciate ligament reconstruction gave similar results, with no significant differences, at one-year follow-up. However, these are only short-term results and only a long-term follow-up can prove or disprove the validity of this conclusion.

• MeSH
• Quadriceps Muscle surgery   MeSH
• Adult MeSH
• Humans MeSH
• Anterior Cruciate Ligament surgery   MeSH
• Adolescent MeSH
• Young Adult MeSH
• Tendons transplantation   MeSH
• Plastic Surgery Procedures methods   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Comparative Study MeSH

Po mnoho let bioinženýři a ortopedi používali principy biomechaniky k získání hodnotných informací nejen o kompletní funkci LCA, ale i ke zlepšení designu náhradních štěpů pro rekonstrukci LCA. Nové experimentální prostředky jako robotický testovací systém a matematické modely byly používány k měření všech šesti stupňů volnosti v kinematice kolene, síly in-situ a biomechanických vlastností LCA. Tento článek dává přehled o specifických případech, jak biomechanika ovlivnila chirurgickou rekonstrukci LCA zlepšením technických faktorů, jako je výběr štěpů, umístění tunelu, iniciální napětí štěpu, fixace štěpu a hojení na rozhraní štěp – tunel. Evoluce jednosvazkové rekonstrukce ACL k více anatomické dvojsvazkové rekonstrukci bude představena. Závěrem je navržena budoucí role biomechaniky k umožnění získávání dat in-vivo pro budoucí zlepšení výsledků rekonstrukce ACL.

For years, bioengineers and orthopaedic surgeons have applied the principles of biomechanics to gain valuable information about the complex function of the ACL, as well as to improve the design of replacement grafts for ACL reconstruction. New experimental tools, such as the robotic testing system and mathematical models, have been used to measure the multiple DOF knee kinematics, in-situ forces and biomechanical properties of the ACL. This article reviews specific examples of how biomechanics has impacted surgical reconstruction of the ACL by improving technical factors, such as graft selection, tunnel placement, initial graft tension, graft fixation, and graft tunnel healing. Evolution of the single bundle ACL reconstruction to the more anatomical double bundle reconstruction is discussed. Finally, the future role of biomechanics to facilitate in-vivo data for further improvement of the outcome of ACL reconstruction is suggested.

• MeSH
• Biomechanical Phenomena radiation effects   trends   MeSH
• Financing, Organized MeSH
• Humans MeSH
• Anterior Cruciate Ligament surgery   physiopathology   pathology   MeSH
• Mathematical Computing MeSH
• Robotics methods   utilization   MeSH
• Transplants utilization   MeSH
• Plastic Surgery Procedures methods   utilization   MeSH
• Check Tag
• Humans MeSH

• MeSH
• Cell Biology MeSH
• Molecular Biology MeSH
• Publication type
• Monograph MeSH

• Conspectus
• Biochemie. Molekulární biologie. Biofyzika
• NML Fields
• biologie
• cytologie, klinická cytologie