Clinical outcomes of single-bundle versus double-bundle ACL reconstruction in adolescent elite athletes: A retrospective comparative study

Clinical outcomes of single-bundle versus double-bundle ACL reconstruction in adolescent elite athletes: A retrospective comparative study

Objective: The aim of the study was to evaluate the single bundle (SB) and double bundle (DB) anterior cruciate ligament (ACL) reconstruction in terms of graft survival, complications, and patient reported functional outcomes in adolescent athletes. Methods: In this retrospective study, 89 elite adolescent athletes who underwent either SB or DB ACL reconstruction were included. All patients were then divided into two groups: group 1 including 51 patients with SB ACL reconstruction (31 male, 20 female; mean age = 15.4 ± 1.03 years) and group 2 including 38 patients with DB ACL (30 male, 8 female; mean age = 15.7 ± 1.3 years). Clinical data were obtained, comprising skeletal maturity, sports type, ACL reconstruction technique, Lachman scores, KT-1000™ arthrometer measurement, additional meniscal procedures as well as International Knee Documentation Committee (IKDC) score, Cincinnati score, and graft size. Results: The mean follow-up period was 53.1 ± 8.6 months in group 1 and 46.4± 9.1 months in group 2 (P = 0.61). The type of ACL reconstruction technique (SB or DB), gender, skeletal maturity, sports type, additional meniscal procedures and Lachman scores were not associated with the re-rupture of the ACL (P > 0.05). Moreover, ACL reconstruction technique did not effect the rate of re-rupture of an ACL. There were 21 re-ruptures (23.5%) and 11 (12.3%) contralateral ACL ruptures in total. Among 21 reruptures, 12 of them were in the DB group while nine of them in the SB group (P > 0.05). The groups did not differ with respect to age, the injured side, the time from injury to surgery, the postoperative follow-up time, or the preoperative physical examination results KT-1000 device (SSD), Cincinnati score, IKDC objective and subjective score,Lachman test and pivot-shift test). Conclusion: There are no differences in the re-rupture of an ACL, patient reported outcomes, and complications in adolescent elite players, when either an SB or DB technique is performed.

___

  • 1. Parkkari J, Pasanen K, Mattila VM, Kannus P, Rimpelä A. The risk for a cruciate ligament injury of the knee in adolescents and young adults: A population-based cohort study of 46 500 people with a 9 year follow-up. Br J Sports Med. 2008;42(6):422-426. 10.1136/bjsm.2008.046185
  • 2. Heath EL, Salmon LJ, Cooper R, Pappas E, Roe JP, Pinczewski LA. 5-year survival of pediatric anterior cruciate ligament reconstruction with living donor hamstring tendon grafts. Am J Sports Med. 2019;47(1):41-51. 363546518804502.
  • 3. Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD. Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: A systematic review and meta-analysis. Am J Sports Med. 2016;44(7):1861-1876. 10.1177/0363546515621554
  • 4. Faunø P, Rahr-Wagner L, Lind M. Risk for revision after anterior cruciate ligament reconstruction is higher among adolescents: Results from the danish registry of knee ligament reconstruction. Orthop J Sports Med. 2014;2 (10):2325967114552405. 10.1177/2325967114552405
  • 5. Lynch TS, Parker RD, Patel RM, et al. The impact of the multicenter orthopaedic outcomes network (moon) research on anterior cruciate ligament reconstruction and orthopaedic practice. J Am Acad Orthop Surg. 2015;23(3):154- 163. 10.5435/JAAOS-D-14-00005
  • 6. Kaeding CC, Pedroza AD, Reinke EK, Huston LJ, Spindler KP. Risk factors and predictors of subsequent acl injury in either knee after acl reconstruction: Prospective analysis of 2488 primary acl reconstructions from the moon cohort. Am J Sports Med. 2015;43(7):1583-1590. 10.1177/ 0363546515578836
  • 7. Schmale GA, Kweon C, Larson RV, Bompadre V. High satisfaction yet decreased activity 4 years after transphyseal acl reconstruction. Clin Orthop Relat Res. 2014;472(7):2168-2174. 10.1007/s11999-014-3561-6
  • 8. Reid D, Leigh W, Wilkins S, Willis R, Twaddle B, Walsh S. A 10-year retrospective review of functional outcomes of adolescent anterior cruciate ligament reconstruction. J Pediatr Orthop. 2017;37(2):133-137. 10.1097/BPO. 0000000000000594
  • 9. DeFrancesco CJ, Storey EP, Flynn JM, Ganley TJ. Pediatric acl reconstruction and return to the operating room: Revision is less than half of the story. J Pediatr Orthop. 2019;39(10):516-520.
  • 10. Shea KG, Pfeiffer R, Wang JH, Curtin M, Apel PJ. Anterior cruciate ligament injury in pediatric and adolescent soccer players: An analysis of insurance data. J Pediatr Orthop. 2004;24(6):623-628. 10.1097/01241398- 200411000-00005
  • 11. Hewett TE, Myer GD, Ford KR. Decrease in neuromuscular control about the knee with maturation in female athletes. J Bone Joint Surg Am. 2004;86(8):1601- 1608. 10.2106/00004623-200408000-00001
  • 12. Tibor L, Chan PH, Funahashi TT, Wyatt R, Maletis GB, Inacio MC. Surgical technique trends in primary acl reconstruction from 2007 to 2014. J Bone Joint Surg Am. 2016;98(13):1079-1089. 10.2106/JBJS.15.00881
  • 13. Eysturoy NH, Nissen KA, Nielsen T, Lind M. The influence of graft fixation methods on revision rates after primary anterior cruciate ligament reconstruction. Am J Sports Med. 2018;46(3):524-530. 10.1177/0363546517748924
  • 14. Snook GA. A short history of the anterior cruciate ligament and the treatment of tears. Clin Orthop Relat Res. 1983;(172):11-13.
  • 15. Marcacci M, Molgora AP, Zaffagnini S, Vascellari A, Iacono F, Presti ML. Anatomic double-bundle anterior cruciate ligament reconstruction with hamstrings. Arthroscopy. 2003;19(5):540-546. 10.1053/jars.2003.50129
  • 16. Dong Z, Niu Y, Qi J, Song Y, Wang F. Long term results after double and single bundle acl reconstruction: Is there any difference? A meta-analysis of randomized controlled trials. Acta Orthop Traumatol Turc. 2019;53(2):92-99. 10. 1016/j.aott.2018.12.004
  • 17. Pyle SI, Waterhouse AM, Greulich WW. Attributes of the radiographic standard of reference for the national health examination survey. Am J Phys Anthropol. 1971;35(3):331-337. 10.1002/ajpa.1330350306
  • 18. Tashman S, Collon D, Anderson K, Kolowich P, Anderst W. Abnormal rotational knee motion during running after anterior cruciate ligament reconstruction. Am J Sports Med. 2004;32(4):975-983. 10.1177/0363546503261709
  • 19. Arciero RA. Double-bundle and single-bundle acl reconstruction techniques did not differ in terms of clinical outcomes at 2 or 5 years. J Bone Joint Surg Am. 2016;98(22):1933-1934. 10.2106/JBJS.16.00883
  • 20. Devgan A, Rohilla R, Singh A, Tanwar M, Devgan R, Siwach K. A prospective study to evaluate the clinico-radiological outcomes of arthroscopic single bundle versus double bundle anterior cruciate ligament reconstruction. J Clin Orthop Trauma. 2016;7(Suppl 2):236-242. 10.1016/j.jcot.2016.01.004
  • 21. Liu Y, Cui G, Yan H, Yang Y, Ao Y. Comparison between single- and double-bundle anterior cruciate ligament reconstruction with 6- to 8-stranded hamstring autograft: A prospective, randomized clinical trial. Am J Sports Med. 2016;44(9):2314-2322. 10.1177/0363546516650876
  • 22. Zhang Z, Gu B, Zhu W, Zhu L. Double-bundle versus single-bundle anterior cruciate ligament reconstructions: A prospective, randomized study with 2-year follow-up. Eur J Orthop Surg Traumatol. 2014;24(4):559-565. 10.1007/ s00590-013-1221-2
  • 23. Gobbi A, Mahajan V, Karnatzikos G, Nakamura N. Single- versus doublebundle acl reconstruction: Is there any difference in stability and function at 3-year followup? Clin Orthop Relat Res. 2012;470(3):824-834. 10.1007/s11999- 011-1940-9
  • 24. Li X, Xu CP, Song JQ, Jiang N, Yu B. Single-bundle versus double-bundle anterior cruciate ligament reconstruction: An up-to-datemeta-analysis. Int Orthop. 2013;37(2):213-226. 10.1007/s00264-012-1651-1
  • 25. Järvelä S, Kiekara T, Suomalainen P, Järvelä T. Double-bundle versus single-bundle anterior cruciate ligament reconstruction: A prospective randomized study with 10-year results. Am J Sports Med. 2017;45(11):2578-2585. 10. 1177/0363546517712231
  • 26. Tiamklang T, Sumanont S, Foocharoen T, Laopaiboon M. Double-bundle versus single-bundle reconstruction for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev. 2012;11(11):Cd008413. 10.1002/ 14651858.CD008413.pub2
  • 27. Aga C, Kartus JT, Lind M, Lygre SHL, Granan LP, Engebretsen L. Risk of revision was not reduced by a double-bundle acl reconstruction technique: Results from the scandinavian registers. Clin Orthop Relat Res. 2017;475 (10):2503-2512. 10.1007/s11999-017-5409-3
  • 28. Lim CR, Henson T, Ebert J, Annear P. Anterior cruciate ligament reconstruction using a double bundle hamstring autograft configuration in patients under 30 years. World J Orthop. 2019;10(12):446-453. 10.5312/wjo.v10.i12.446
  • 29. Mishra P, Lal A, Mohindra M, Mehta N, Joshi D, Chaudhary D. Incidence, management and outcome assessment of post operative infection following single bundle and double bundle acl reconstruction. J ClinOrthop Trauma. 2018;9(2):167-171. 10.1016/j.jcot.2017.09.017
  • 30. Pennock A, Murphy MM, Wu M. Anterior cruciate ligament reconstruction in skeletally immature patients. Curr Rev Musculoskelet Med. 2016;9(4):445-453. 10.1007/s12178-016-9367-2
  • 31. Collins MJ, Arns TA, Leroux T, et al. Growth abnormalities following anterior cruciate ligament reconstruction in the skeletally immature patient: A systematic review. Arthroscopy. 2016;32(8):1714-1723. 10.1016/j.arthro.2016.02.025
  • 32. Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, et al. Return to sport after anterior cruciate ligament reconstruction in professional soccer players. The Knee. 2014;21(3):731-735. 10.1016/j.knee.2014.02.005
  • 33. Beischer S, Gustavsson L, Senorski EH, et al. Young athletes who return to sport before 9 months after anterior cruciate ligament reconstruction have a rate of new injury 7 times that of those who delay return. J Orthop Sports Phys Therapy. 2020;50(2):83-90. 10.2519/jospt.2020.9071
  • 34. Paterno MV, Huang B, Thomas S, Hewett TE, Schmitt LC. Clinical factors that predict a second acl injury after acl reconstruction and return to sport: Preliminary development of a clinical decision algorithm. Orthop J Sports Med. 2017;5(12):2325967117745279. 10.1177/ 2325967117745279
  • 35. Kostyun RO, Burland JP, Kostyun KJ, Milewski MD, Nissen CW. Male and female adolescent athletes’ readiness to return to sport after anterior cruciate ligament injury and reconstruction. Clin J Sport Med. 2021;31 (4):383-387.
Acta Orthopaedica et Traumatologica Turcica-Cover
  • ISSN: 1017-995X
  • Başlangıç: 2015
  • Yayıncı: Türk Ortopedi ve Travmatoloji Derneği
Sayıdaki Diğer Makaleler

Clinical outcomes of single-bundle versus double-bundle ACL reconstruction in adolescent elite athletes: A retrospective comparative study

Tunay ERDEN, Göksel DİKMEN, Berkin TOKER, Vahit Emre Özden, Göktuğ FIRATLI, Ömer TAŞER

Adequacy of spine surgery fellowship training in Turkey: Results of a survey

Kadir ABUL

Preliminary results of iliosacral screws and plate combination in the management of tile B3 pelvic fractures: A retrospective case series

Wei-Bin WANG, Qing-Song FU, Xin-Hua YUAN, Yi ZHENG, Yi-Hong YIN

Is elective surgery during the COVID-19 pandemic safe? A multi-center prospective study in a high incidence area

Silvia M MIGUELA, Pere TORNER, Sergi SASTRE, Montsant JORNET-GORBET, Guillem CLARET, Irene PORTAS-TORRES, Christian YELA-VERDU, Mariano BALAGUER-CASTRO, Laia BRUNET

External fixation in the treatment of displaced supracondylar femoral fracture in children: A retrospective case series

Kailei CHEN, Xikai GUO, Saroj RAI, Jin LI, Xin TANG, Jiewen MA, Changjie YUE

Analysis of risk factors for re-displacement of pediatric tibia fractures: A retrospective study of 196 cases

Ali TURGUT, Sertan HANCIOĞLU, Mert KUMBARACI

The load transfer effect of monopolar and bipolar radial head prosthesis designs on capitellar cartilage: A comparative biomechanical cadaver study

Abdullah Meriç ÜNAL, Mustafa ÖZKAN, Necmettin TURGUT, Ahmet EKİN, Mehmet AKDEMİR, Mehmet Ozan AŞIK

Dorsal plating versus volar plating with limited dorsal open reduction in the management of AO type C3 distal radius fractures with impacted articular fragments: A retrospective comparative study

Jong Hun BAEK, Jae Hoon LEE, Jung Tae AHN

Comparison of efficacy of Oral versus Intra-articular Corticosteroid Application in the treatment of Frozen Shoulder: An experimental study in rats

Ümit Özgür GÜLER, Vahit Erdal BATTAL, Nebil BAL, Salih BEYAZ, Bekir Murat ÇINAR

Effect of platelet-rich plasma on bone regenerate consolidation in distraction osteogenesis: An experimental study in rabbits

Bartu SARISÖZEN, Mehmet KARAKAYALI, Yakup ALPAY