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General Orthopaedics

COMPARISON OF ISOLATED AM BUNDLE AND PL BUNDLE AUGMENTATION IN ACL RECONSTRUCTION

The International Society for Computer Assisted Orthopaedic Surgery (CAOS)



Abstract

This prospective study was undertaken to compare the clinical and radiological results and the in vivo stabilities of anteromedial (AM) and posterolateral (PL) bundle augmentation during anterior cruciate ligament (ACL) reconstruction.

Forty-two ACL partial tears that underwent isolated bundle augmentation (22 AM and 20 PL bundles) were evaluated with a minimum follow-up of 1 year. For in vivo intraoperative stability testing, anteroposterior and external/internal rotation stabilities were measured at 0, 30, 60, and 90° of flexion using a navigation system. Ranges of motion, Lachman and pivot shift test results, Tegner activity scores, and Lysholm knee scores of the AM and PL bundle groups were compared. In addition, Telos arthrometer determined stabilities were compared.

In-vivo intraoperative stability testing showed that mean preoperative anterior translation at 30° of flexion was greater in the AM group (8.7 vs. 6.5, p = 0.04), whereas mean rotational amount was larger in the PL group (by 2.9 at 0° and 3.6 at 30° of flexion). After ACL reconstruction, no significant differences were found between the two groups in terms of anterior and rotational stabilities at any flexion angle. Furthermore, clinical outcomes in the two groups were not significantly different. Lachman and pivot shift test results and instrumented laxity findings were similar for the two groups at final follow up.

In this study, the authors carefully preserved the remnant injured ACL, and achieved excellent anterior stability recoveries and good rotatory stabilities. No significant intergroup difference was found in terms of intraoperative stability or clinical parameters after ACL reconstruction.