A comparative analysis of arthroscopic double-bundle versus single-bundle posterior cruciate ligament reconstruction using hamstring tendon autograft

• Published in: Archives of orthopaedic and trauma surgery 2016-11, Vol.136 (11), p.1555-1561
• Main Authors: Jain, Vineet, Goyal, Ankit, Mohindra, Mukul, Kumar, Rahul, Joshi, Deepak, Chaudhary, Deepak
• Format: Article
• Language: English
• Subjects: Adult; Arthroscopy - methods; Arthroscopy and Sports Medicine; Autografts; Female; Hamstring Tendons - transplantation; Humans; Knee; Knee Injuries - diagnosis; Knee Injuries - surgery; Male; Medicine; Medicine & Public Health; Orthopedics; Posterior Cruciate Ligament - diagnostic imaging; Posterior Cruciate Ligament - injuries; Posterior Cruciate Ligament - surgery; Posterior Cruciate Ligament Reconstruction - methods; Retrospective Studies
• ISSN: 0936-8051; 1434-3916
• DOI: 10.1007/s00402-016-2512-y

Purpose Anatomically, posterior cruciate ligament (PCL) consists of two bundles, i.e. anterolateral (AL) and posteromedial (PM) bundle. Single-bundle PCL (SBPCL) reconstruction remains most popular method of reconstruction, though double-bundle PCL (DBPCL) reconstruction is more anatomical. This study was done to analyse the clinical and functional outcome after both SBPCL and DBPCL reconstructions using autologous hamstring grafts. Methods This was a retrospective study including patients who underwent either DBPCL or SBPCL reconstruction for chronic symptomatic PCL injury. Clinical, functional and radiological evaluation was done pre-operatively and 3 months post-operatively and thereafter at every 6-month interval. Patients with a minimum follow-up of 24 months were included in the study. Pre-operative posterior translation was quantified by manual posterior drawer, KT 1000 measurement and stress radiography. Functional outcome was done using Lysholm and IKDC scores. MRI was done in all patients. Results Records of 40 patients were available with minimum follow-up of 24 months. Out of these, DBPCL reconstruction was done in 18 patients and SBPCL reconstruction was done in 22 patients. Four patients in DB (double-bundle PCL reconstruction) group and five in SB (single-bundle PCL reconstruction) group had more than grade I laxity by posterior drawer and on KT 1000 measurement DB group had average side-to-side difference of 1.78 mm and SB group 2.44 mm ( p value = 0.0487). On functional assessment by Lysholm and IKDC score, there was significant improvement from pre-operative values in both the groups with no significant difference between the groups post-operatively. Stress radiography revealed significantly less post-translation in DB group as compared to SB group. Conclusion Though DBPCL reconstruction results in less posterior laxity, there is no difference in functional outcome of SBPCL and DBPCL reconstructions. Level of evidence III.