Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction
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概要
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Several double-bundle anterior cruciate ligament (ACL) reconstruction procedures were reported in the 1980s and 1990s. However, no significant differences were found in the clinical results between these double-bundle procedures and single-bundle procedures because the double-bundle procedures appeared to reconstruct only the anteromedial bundle with two bundles. In the early 2000s, the authors proposed a new concept of anatomic reconstruction of the anteromedial and posterolateral bundles, in which 4 independent tunnels were created through the center of each anatomic attachment of the 2 bundles. We named it "anatomic" double-bundle ACL reconstruction. Biomechanical studies have shown that the anatomic double-bundle ACL reconstruction can restore knee stability significantly closer to the normal level than the conventional single-bundle reconstruction. Recent intraoperative measurement studies have showed that the clinically available anatomic double-bundle procedures can reconstruct knee stability significantly better and improve knee function close to the normal level at the time immediately after surgery than the conventional single-bundle procedures. However, the greatest criticism of the anatomic double-bundle reconstruction is whether the clinical results of anatomic double-bundle reconstruction are better than the results of single-bundle reconstruction. Currently, 10 prospective comparative clinical trials (Level I or II) and 1 meta-analysis have been reported to date (January, 2010) that compare single-bundle and anatomic double-bundle reconstructions using hamstring tendons. In 8 of the 10 studies, the anterior and/or rotatory stability of the knee was significantly better in the anatomic double-bundle ACL reconstruction than the conventional single-bundle reconstruction. However, 1 original trial and the meta-analysis found that there were no differences in the results between the 2 types of reconstructions. Thus, the utility of the anatomic double-bundle reconstruction has not yet been established. Our systematic review shows how much evidence exists as to the benefits of double-bundle ACL reconstruction at the present time.
著者
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Yasuda Kazunori
北海道大学 医学研究科人工関節･再生医学
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Yasuda Kazunori
Department Of Sports Medicine And Joint Reconstruction Surgery Hokkaido University Graduate School O
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