Intraoperative Correlation Analysis Between Tunnel Position and Translational and Rotational Stability in Single- and Double-Bundle Anterior Cruciate Ligament Reconstruction

Abstract

Purpose: To determine the relation between the tunnel positions and the kinematic improvement of the knee joint after single-bundle (SB) and double-bundle (DB) anterior cruciate ligament (ACL) reconstructions. Methods: The study included 42 patients who underwent either SB (n = 21) or DB (n = 21) ACL reconstruction using hamstring tendon autograft. Anterior tibial translation and rotational laxity were measured by a navigation system before and after graft fixation. Three-dimensional computed tomography measurement was conducted for evaluation of tunnel placements. Regression analysis was carried out to determine the association between the postoperative kinematic change and the tunnel position. Results: The average tunnel location was mostly different between the SB and posterolateral bundle (PLB) tunnels, as well as between the anteromedial bundle (AMB) and PLB tunnels of DB ACL reconstructions, whereas the SB and AMB tunnels were similar in the tibial mediolateral and femoral deep-shallow positions. A regression curve showed that the PLB femoral tunnel position was correlated with rotation whereas both the SB and AMB femoral tunnel locations were mostly correlated with anterior tibial translation. Conclusions: The PLB tunnel location in DB ACL reconstruction had a considerable effect on rotational laxity, whereas the SB and AMB tunnel locations mostly influenced anterior tibial translation.