ACL paper

Title: Study Area Coverage Of Simulated Single Vs Double Bundle ACL Reconstruction In Femoral And Tibial Footprint In Cadaver Knee Joints
Institution: Institute of Orthopaedics, Lerdsin Hospital, Bangkok, , THAILAND
All Authors: Suriyapong Saowaprut MD, Bangkok, THAILAND, Presenter
Nathawoot Sawasdee MD, Bangkok, THAILAND
Apisan Chinanuvathana MD, Bangkok, THAILAND
Natthaphon Surachtnanan MD, Bangkok, THAILAND
Presenting Author: Suriyapong Saowaprut, MD
Presenting Author ID: 6041
Summary: Single bundle reconstruction significantly maximize more area covering footprint than double bundle reconstruction on femoral sides; but double bundle reconstruction on femoral side should be performed in case of ratio width and length of ACL femoral footprint less than 0.65 and single bundle reconstruction on tibial side in case of ratio width and length of ACL tibial footprint more than 0.7.
Abstract: ABSTRACT: Anatomical ACL reconstruction have been discussed in many aspects of single and double bundle techniques. The objective of this study is to compare area coverage of simulated single and double bundle ACL reconstruction in femoral and tibial footprint in cadaver knee joints by hypothesis from observation that femoral footprint is more circular in shape, and tibial footprint is more triangular or oval in shape .Then, in femoral side, the ACL should be reconstructed in single bundle, and in tibia side, it should be reconstructed in double bundle for the maximum area coverage within footprint. METHODS : Sixty-nine human cadaver knees were carefully dissected of ACL footprint then measured area of footprint and maximum simulated circular area for both single and double bundle reconstruction by using image J software (National institute of Health) on each femoral and tibial footprint. The maximum coverage circular area of double bundle fitting for the footprint with at least 2 mm bone bridge was simulated first. Then, the maximum coverage circular area of single bundle fitting for the footprint was simulated in the middle of previously simulated two bundles and not over the footprint. Percentage of area coverage (area of simulated bundle reconstruction/measured area on footprint*100) was calculated and analyzed by statistic method (Pearson’s correlation and pair T-test). RESULTS: The average cadaveric ACL footprint area on femoral side was 80.97±28.8 mm² and area on tibial side was 148.12±38.8 mm² , average maximum simulated area size of single and double bundle on femoral side were 46.09±16.14 and 39.82±20.37 mm² respectively, average maximum simulated area size of single and double bundle on tibial side were 77.05±24.79 and 72.77±24.84 mm² respectively . The analysis showed significant difference in percentage of area coverage between simulated area of single bundle and double bundle on femoral side, pair T-test at p < 0.01 (95%CI 5.94,15.86), and data showed no significant difference in percentage of area coverage between simulated area of single bundle and double bundle on tibial side, pair T-test at p=0.14 (95%CI -1.09,7.88). In subgroup analysis on femoral sides, we analyze relation between coverage ratio of simulated footprint and ratio of width and length of femoral footprint. The analysis showed higher simulated area coverage of double bundle than single bundle in femoral footprint having ratio of width and length less than 0.65 by comparing T-test p=0.003 (95%CI, 0.398-9.013). On tibial sides, we analyze relation between coverage ratio of simulated footprint and ratio of width and length of tibial footprint. The analysis showed higher simulated area coverage of single bundle than double bundle in tibial footprint having ratio of width and length more than 0.7 by comparing T-test p<0.01 (95%CI 12.30-30.25). CONCLUSIONS : In the aspect of percentage area coverage, our finding showed that single bundle reconstruction significantly maximize more area covering footprint than double bundle reconstruction on femoral sides ; however, we suggest to perform double bundle reconstruction on femoral side in case of ratio width and length of ACL femoral footprint less than 0.65. We suggest to perform single bundle reconstruction on tibial side in case of ratio width and length of ACL tibial footprint more than 0.7. CLINICAL RELEVANCE: This study can help the surgeon to understand how to produce maximum footprint coverage ACL reconstruction on both femoral and tibial side.
Category: Basic Science, Ligaments, Knee, ACL, Instability, Double Bundle, Adult

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