Double tibial tunnels 'supra' over-the-top anterior cruciate ligament reconstruction with lower initial graft tension achieves comparable anterior stability to single-tunnel: A cadaveric study using a robotic simulator.
biomechanical · Level V
Where this comes from
- Record sourced from PubMed, PMID 41333626.
- Also identified by DOI 10.1002/jeo2.70466 and PMC identifier 12666155.
- Licence recorded as CC BY.
- The licence permits redistribution, so the abstract is shown in full and the full text is available from the publisher.
Abstract
To compare the anterior tibial translation (ATT) between single-bundle (SB) and double-bundle (DB) 'supra'-over-the-top anterior cruciate ligament reconstruction (s-OTT ACLR) during the anterior drawer test in a cadaveric model. This was a controlled laboratory study. Seven fresh-frozen cadaveric knee specimens and a robotic testing system were used. Initially, the same testing procedure (100 N anterior drawer load applied at 0°, 15°, 30°, 60° and 90° of knee flexion) was applied to the following four different knee conditions: intact, anterior cruciate ligament (ACL)-sectioned, SB s-OTT ACLR and DB s-OTT ACLR knees. Subsequently, a combined load of 5 Nm internal tibial torque and 10 Nm valgus torque was applied at 15° and 30° of knee flexion as a simulated pivot shift. During the tests, anterior tibial translation (ATT) was recorded. The initial tension was set at 22 N for the SB s-OTT ACLR and 11 N for each graft in the DB s-OTT ACLR at 30° of knee flexion. For the SB s-OTT ACLR with an 8-mm-diameter tibial tunnel, the drilling area was 16 Π mm² (4 × 4 × Π). Regarding the DB s-OTT ACLR with two 5-mm-diameter tibial tunnels, the total drilling area was 12.5 Π mm² (2.5 × 2.5 × Π × 2). Both SB and DB s-OTT ACL reconstructions significantly reduced ATT compared with the ACL-sectioned state under both anterior drawer and simulated pivot-shift loads, while showing no difference from the intact knee. No significant ATT difference was detected between SB and DB s-OTT ACLRs at any tested flexion angle, and DB achieved anterior knee stability comparable to SB despite its lower initial graft tension. DB s-OTT ACLR demonstrated ATT and in situ graft force comparable to SB s-OTT ACLR in a cadaveric robotic study. These findings suggest that DB s-OTT ACLR can achieve anterior knee stability similar to SB s-OTT ACLR with lower initial graft tension. N/A.