A Biomechanical Comparison of Posterior Cruciate Ligament Reconstructions Using Single- and Double-Bundle Tibial Inlay Techniques

Lutheran Medical Center, Brooklyn, New York, United States
The American Journal of Sports Medicine (Impact Factor: 4.36). 08/2005; 33(7):976-81. DOI: 10.1177/0363546504273046
Source: PubMed


The efficacy of using a double-bundle versus single-bundle graft for posterior cruciate ligament reconstruction has not been demonstrated.
A double-bundle graft restores knee kinematics better than a single-bundle graft does in tibial inlay PCL reconstructions.
Controlled laboratory study.
Eight cadaveric knees were subjected to 6 cycles from a 40-N anterior reference point to a 100-N posterior translational force at 10 degrees , 30 degrees , 60 degrees , and 90 degrees of flexion. Testing was performed for the intact and posterior cruciate deficient knee as well as for both reconstructed conditions. Achilles tendons, divided into 2 equal sections, were prepared as both single-bundle and double-bundle grafts. Both grafts were employed in the same knee, and the order of graft reconstruction was randomized.
There were no statistical differences in translation between the intact state and either of the reconstructions (P > .05) or between either of the reconstructions at any flexion angle (P > .05).
No differences in translation between the 2 graft options were identified.
The use of a double-bundle graft may not offer any advantages over a single-bundle graft for tibial inlay posterior cruciate reconstructions.

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    • "Despite the improved stability single-bundle reconstructions have achieved, the stability of the intact knee has not been fully restored. The work of Bergfeld et al.[25]conflicts with these five studies by showing no significant improvement in AP stability using tibial inlay Achilles tendon grafts of the same overall size in single-and double-bundle reconstructions. Therefore, conflicting biomechanical studies with complex procedural differences do not show a definite advantage of double-bundle PCL reconstruction. "
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    ABSTRACT: Background Posterior Cruciate Ligament (PCL) ruptures are common sports injuries. One of the key controversies in PCL reconstruction is whether double-bundle reconstruction provides biomechanical and clinical outcomes superior to single-bundle reconstruction. Methods We performed a comprehensive search in multiple databases to evaluate the advantages of single-bundle or double bundle reconstructions in anteroposterior stability, graft tension, rotational stability, and functional outcome. Results Biomechanical comparisons evaluating anteroposterior stability described either no difference or increased stability in double-bundle reconstructions. Comparing these results is complicated by different graft choices, tensioning techniques, and tunnel positions. Biomechanical studies of graft tension demonstrated conflicting results regarding the optimal reconstruction technique. Seven retrospective clinical studies of single- and double-bundle reconstructions with methodological limitations reported no difference in clinical outcome. Conclusions The superiority of single-bundle or double-bundle posterior cruciate ligament reconstruction remains uncertain.
    Full-text · Article · Dec 2016 · BMC Musculoskeletal Disorders
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    • "Harner et al.8) also reported that double bundle reconstruction resulted in better restoration of posterior stability, compared with single bundle reconstruction in cadaveric knees. However, in some studies,4-6,23,24) in terms of posterior stability, few differences were observed between single and double bundle PCL reconstruction, even though some different results were reported with different experimental settings. "
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    ABSTRACT: There is little consensus on how to optimally reconstruct the posterior cruciate ligament (PCL) and the natural history of injured PCL is also unclear. The graft material (autograft vs. allograft), the type of tibial fixation (tibial inlay vs. transtibial tunnel), the femoral tunnel position within the femoral footprint (isometric, central, or eccentric), and the number of bundles in the reconstruction (1 bundle vs. 2 bundles) are among the many decisions that a surgeon must make in a PCL reconstruction. In addition, there is a paucity of information on rehabilitation after reconstruction of the PCL and posterolateral structures. This article focused on the conflicting issues regarding the PCL, and the scientific rationales behind some critical points are discussed.
    Full-text · Article · Dec 2013 · Clinics in orthopedic surgery
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    • "In a prospective, nonrandomized comparison of single bundle and double bundle transtibial reconstructions, Wang et al.29) did not detect any significant difference between the two techniques at a minimum of two years postoperatively. For a tibial inlay reconstruction, Bergfeld et al.30) compared single and double-bundle reconstructions using the tibial inlay technique of the posterior cruciate ligament based on cadaveric studies. They reported no differences in posterior tibial translation and concluded that it unnecessary to perform a double-bundle reconstruction of the posterior cruciate ligament if a tibial inlay construct is used. "
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    ABSTRACT: This study evaluated the clinical results of arthroscopically assisted single and double bundle tibial inlay reconstructions of an isolated posterior cruciate ligament (PCL) injury. This study reviewed the data for 14 patients who underwent a single bundle tibial inlay PCL reconstruction (Group A) and 16 patients who underwent a double bundle tibial inlay PCL reconstruction (Group B) between August 1999 and August 2002. The mean follow-up period in groups A and B was 90.5 months and 64 months, respectively. The Lysholm knee scores in groups A and B increased from an average of 43.3 +/- 7.04 and 44.7 +/- 5.02 preoperatively to 88.1 +/- 7.32 and 88.7 +/- 9.11 points at the final follow-up, respectively. In group A, stress radiography using a Telos device showed that the preoperative mean side-to-side differences (SSDs) of 9.5 +/- 1.60 mm at 30 degrees of flexion and 9.8 +/- 1.70 mm at 90 degrees of flexion were improved to 2.8 +/- 1.19 mm and 3.0 +/- 1.1 mm, respectively. In group B, the preoperative SSDs of 10.4 +/- 1.50 mm at 30 degrees of flexion and 10.7 +/- 1.60 mm at 90 degrees of flexion improved to 2.7 +/- 1.15 mm and 2.6 +/- 0.49 mm, respectively. There was no significant difference in the clinical scores and radiologic findings between the two groups. Single bundle and double bundle PCL reconstructions using the tibial inlay technique give satisfactory clinical results in patients with an isolated PCL injury, and there are no significant differences in the clinical and radiological results between the two techniques. These results suggest that it is unnecessary to perform the more technically challenging double bundle reconstruction using the tibial inlay technique in an isolated PCL injury.
    Full-text · Article · Jun 2010 · Clinics in orthopedic surgery
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