Journal
ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY
Volume 25, Issue 5, Pages 488-495Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.arthro.2008.10.008
Keywords
Anterior cruciate ligament; Anteromedial bundle; Double-bundle reconstruction; Navigation; Pivot- shift; Posterolateral bundle
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Purpose: The purpose of this study was to assess the pivot-shift phenomenon during double-bundle anterior cruciate ligament (ACL) reconstruction using a navigation system. Methods: Ninety patients who received navigated double-bundle ACL reconstruction were included in this study. The mean age of the patients was 21.9 years. During reconstruction, pivot-shift tests were performed 4 times: before reconstruction, after the posterolateral bundle fixation, after the anteromedial bundle fixation, and after the double-bundle reconstruction. Both tibial internal rotation and anterior translation under the pivot-shift test were measured at each phase by the additional functions of the navigation. The navigation system used in this study was the image-free, which does not require preoperative or intraoperative images, OrthoPilot ACL (version 2.0; B. Braun Aesculap, Tuttlingen, Germany). Results: Before ACL reconstruction, average (+/- standard deviation) tibial internal rotation and anterior translation under the pivot-shift test were 23.7 degrees +/- 6.1 degrees and 5.2 +/- 2.4 mm. They were significantly decreased to 20.9 degrees +/- 6.4 degrees and 2.3 +/- 1.1 mm after the posterolateral bundle fixation, and also decreased to 22.2 degrees +/- 5.7 degrees and 2.4 +/- 1.1 min after the anteromedial bundle fixation. There was no significant difference between the groups. After double-bundle reconstruction, they improved to 20.3 degrees +/- 6.3 degrees and 2.0 +/- 1.0 mm. Conclusions: Our results indicate that both the posterolateral and the anteromedial bundle similarly control both anterior translation and internal rotation during pivot-shift testing. Double-bundle reconstruction may further improve knee stability.
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