Biomechanical Comparison of Anatomic Double-Bundle, Anatomic Single-Bundle, and Nonanatomic Single-Bundle Anterior Cruciate Ligament Reconstructions

Background: Although both anatomic double-bundle and single-bundle anterior cruciate ligament reconstruction procedures are in use, it remains controversial whether the anatomic double-bundle procedure is biomechanically superior. Hypothesis: The anatomic double-bundle procedure would be better than both laterally placed anatomic and nonanatomic trans-tibial single-bundle procedures at restoring to normal the tibial anterior translation, internal rotation, and pivot-shift instability. It was also hypothesized that tibial internal rotation would be closer to normal after laterally placed anatomic single-bundle reconstruction than after the nonanatomic reconstruction. Study Design: Controlled laboratory study. Methods: Eight cadaveric knees were mounted in a 6 degrees of freedom rig and tested using the following loading conditions: 90-N anterior and posterior tibial forces, 5-N.m internal and external tibial rotation torques, and a simulated pivot-shift test. Tibio-femoral kinematics during the flexion-extension cycle were recorded with an optical tracking system for (1) intact, (2) anterior cruciate ligament-deficient knee, (3) anatomic double-bundle reconstruction, (4) nonanatomic single-bundle reconstruction, and (5) laterally placed single-bundle reconstruction. Results: Rotational laxity with internal tibial torque and anterior laxity in the simulated pivot shift were significantly less in the double-bundle reconstruction and laterally placed single-bundle reconstruction compared with the nonanatomic single-bundle reconstruction. There were no significant differences between the 3 procedures when anterior and posterior tibial translation forces and external rotation torques were applied. In addition, there were no significant differences between the double-bundle reconstruction and laterally placed single-bundle reconstruction. Conclusion: The postoperative rotational and pivot-shift laxity after anatomic double-bundle anterior cruciate ligament reconstruction was significantly better than that after nonanatomic single-bundle reconstruction. However, there were no significant differences between the double-bundle reconstruction and laterally placed single-bundle reconstruction.