Return to Sport and Re-Injury Rate after Double-Bundle Anterior Cruciate Ligament Reconstruction with at least Five Years of Follow-Up

Document Type : RESEARCH PAPER

Authors

Instituto Vita, São Paulo, Brazil

Abstract

Background: This study retrospectively evaluated the medium- and long-term results of patients submitted to double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. Methods: A retrospective study of case series at a single center. Cases submitted to isolated ACL reconstruction with at least five years of follow-up were included. The following data were collected: demographic data; practice of competitive sport before the injury; previous surgery; injury/surgery in the contralateral knee; return to the practices of sports and level; re-injury (postoperative time; mechanism; need for surgery); and symptoms at the last clinical follow-up visit. Descriptive and sub-group analyses were performed. Results: Sixty-nine patients were included; 52 men (75%), 49 athletes (71%), 47 (68%) with primary injury, mean age of 30 years (SD 10). The patients were followed up for an average of 8.7 years (minimum 5, maximum 11.8) after surgery. After the reconstruction, 67 (97%) returned to the sport; 75% at the same level as before the injury. Ten patients (14%) suffered re-injury after an average of 32 months (between 9 and 50 months). Regarding the outcome of re-injury, no statistically significant differences were found between subgroups of athletes vs non-athletes or primary injury vs revision surgery, despite a significant tendency towards increased re-injury levels in athletes. However, this tendency was not statistically significant. Conclusion: In our series of patients operated on with the double-bundle technique and with a long follow-up time, 14% presented re-injury, with no differences between primary and revision cases, and with a trend towards higher re-injury levels among the athletes in relation to the non-athletes. The rate of return to sport was satisfactory, with 97%, of which 75% were playing at the same level as before the injury. Level of evidence: IV

Keywords


1. Zhu Y, Jiang C, Song G. Arthroscopic Versus Open Latarjet in the Treatment of Recurrent Anterior Shoulder Dislocation with Marked Glenoid Bone Loss: A Prospective Comparative Study. Am J Sports Med. 2017;45(7):1645–53.
2. Georgoulis AD, Ristanis S, Chouliaras V, Moraiti C, Stergiou N. Tibial rotation is not restored after ACL reconstruction with a hamstring graft. Clin Orthop Relat Res. 2007;Jan(454):89–94.
3. Ahlden M, Sernert N, Karlsson J, Kartus J. A prospective randomized study comparing double- and single-bundle techniques for anterior cruciate ligament reconstruction. Am J Sports Med. 2013;41(11):2484–91.
4. Komzák M, Hart R, Feranec M, Šmíd P, Kocová R. In vivo knee rotational stability 2 years after double-bundle and anatomic single-bundle ACL reconstruction. Eur J Trauma Emerg Surg. 2018;44(1):105–11.
5. Kondo E, Merican AM, Yasuda K, Amis AA. Biomechanical comparisons of knee stability after anterior cruciate ligament reconstruction between 2 clinically available transtibial procedures: Anatomic double bundle versus single bundle. Am J Sports Med. 2010;38(7):1349–58.
6. Björnsson H, Desai N, Musahl V, Alentorn-Geli E, Bhandari M, Fu F, et al. Is double-bundle anterior cruciate ligament reconstruction superior to single-bundle? A comprehensive systematic review. Knee Surgery, Sport Traumatol Arthrosc. 2015;23(3).
7. Qiu X-S, Jiang H, Qian B-P, Wang W-J, Zhu F, Zhu Z-Z, et al. Influence of prone positioning on potential risk of aorta injury from pedicle screw misplacement in adolescent idiopathic scoliosis patients. 27(5):E162--167.
8. Zaffagnini S, Bruni D, Marcheggiani Muccioli GM, Bonanzinga T, Lopomo N, Bignozzi S, et al. Single-bundle patellar tendon versus non-anatomical double-bundle hamstrings ACL reconstruction: a prospective randomized study at 8-year minimum follow-up. Knee Surg Sports Traumatol Arthrosc. 2011;19(3):390–7.
9. Jarvela T. Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective, randomize clinical study. Knee Surg Sport Traumatol Arthrosc. 2007;15(5 SRC-BaiduScholar FG-0):500–7.
10. Kong L, Liu Z, Meng F, Shen Y. Single-bundle versus double-bundle anterior cruciate ligament reconstruction: A systematic review and meta-analysis. Int J Clin Exp Med. 2017;10(1):1–15.
11. Järvelä T, Moisala A-S, Sihvonen R, Järvelä S, Kannus P, Järvinen M. Double-bundle anterior cruciate ligament reconstruction using hamstring autografts and bioabsorbable interference screw fixation: prospective, randomized, clinical study with 2-year results. Am J Sports Med. 2008;36:290–7.
12. Yoon JW, Wang MY. The evolution of minimally invasive spine surgery. Spine J. 2019;30:149–58.
13. Dong Z, Niu Y, Qi J, Song Y, Wang F. Long term results after double and single bundle ACL reconstruction: Is there any difference? A meta - analysis of randomized controlled trials. Acta Orthop Traumatol Turc. 2019 Mar 1;53(2):92–9.
14. Järvelä S, Kiekara T, Suomalainen P, Järvelä T. Double-Bundle Versus Single-Bundle Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study With 10-Year Results. Am J Sports Med. 2017;45(11):2578–85.
15. Svantesson E, Sundemo D, Hamrin Senorski E, Alentorn-Geli E, Musahl V, Fu FH, et al. Double-bundle anterior cruciate ligament reconstruction is superior to single-bundle reconstruction in terms of revision frequency: a study of 22,460 patients from the Swedish National Knee Ligament Register. Knee Surgery, Sport Traumatol Arthrosc. 2017 Dec 1;25(12):3884–91.
16. Mayr HO, Bruder S, Hube R, Bernstein A, Suedkamp NP, Stoehr A. Single-Bundle Versus Double-Bundle Anterior Cruciate Ligament Reconstruction—5-Year Results. Arthrosc - J Arthrosc Relat Surg. 2018 Sep 1;34(9):2647–53.
17. Mohtadi NG, Chan DS. A Randomized Clinical Trial Comparing Patellar Tendon, Hamstring Tendon, and Double-Bundle ACL Reconstructions: Patient-Reported and Clinical Outcomes at 5-Year Follow-up. J Bone Jt Surg - Am Vol. 2019 Jun 5;101(11):949–60.
18. D’Elia CO, Bitar AC, Castropil W, Garofo AGP, Cantuária AL, Orselli MIV, et al. Anterior cruciate ligament reconstruction using the double bundle technique - evaluation in the biomechanics laboratory. Rev Bras Ortop. 2011;46(2):148–54.
19. D’Elia CO. Estudo comparativo da avaliação da rotação dos joelhos submetidos à reconstrução do ligamento cruzado anterior: feixe duplo x feixe simples [Internet]. Faculdade de Medicina da Universidade de São Paulo; 2014. Available from: https://www.teses.usp.br/teses/disponiveis/5/5140/tde-16032015-151434/publico/CaioOliveiraDelia.pdf
20. Wright RW, Magnussen RA, Dunn WR, Spindler KP. Ipsilateral graft and contralateral ACL rupture at five years or more following ACL reconstruction: A systematic review. J Bone Jt Surg - Ser A. 2011 Jun 15;93(12):1159–65.
21. Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD. Risk of Secondary Injury in Younger Athletes after Anterior Cruciate Ligament Reconstruction. Vol. 44, American Journal of Sports Medicine. SAGE Publications Inc.; 2016. p. 1861–76.
22. George MS, Dunn WR, Spindler KP. Current concepts review: Revision anterior cruciate ligament reconstruction. Vol. 34, American Journal of Sports Medicine. 2006. p. 2026–37.
23. Suomalainen P, Järvelä T, Paakkala A, Kannus P, Järvinen M. Double-bundle versus single-bundle anterior cruciate ligament reconstruction: A prospective randomized study with 5-year results. Am J Sports Med [Internet]. 2012 Jul [cited 2020 Oct 7];40(7):1511–8. Available from: https://pubmed.ncbi.nlm.nih.gov/22691456/
24. Grassi A, Kim C, Marcheggiani Muccioli GM, Zaffagnini S, Amendola A. What Is the Mid-term Failure Rate of Revision ACL Reconstruction? A Systematic Review. Clin Orthop Relat Res. 2017 Oct 1;475(10):2484–99.
25. Yoon KH, Kim JS, Kim SJ, Park M, Park SY, Park SE. Eight-year results of transtibial nonanatomic single-bundle versus double-bundle anterior cruciate ligament reconstruction: Clinical, radiologic outcomes and survivorship. J Orthop Surg (Hong Kong) [Internet]. 2019 [cited 2020 Jan 27];27(2):2309499019840827. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30955412
26. Kyritsis P, Bahr R, Landreau P, Miladi R, Witvrouw E. Likelihood of ACL graft rupture: Not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. Br J Sports Med. 2016 Aug 1;50(15):946–51.
27. Sepúlveda F, Sánchez L, Amy E, Micheo W. Anterior cruciate ligament injury: Return to play, function and long-term considerations. Curr Sports Med Rep. 2017 Jun 1;16(3):172–8.
28. Lai CCH, Ardern CL, Feller JA, Webster KE. Eighty-three per cent of elite athletes return to preinjury sport after anterior cruciate ligament reconstruction: A systematic review with meta-analysis of return to sport rates, graft rupture rates and performance outcomes. In: British Journal of Sports Medicine. BMJ Publishing Group; 2018. p. 128–38.
29. Volpi P, Quaglia A, Carimati G, Galli M, Papalia R, Petrillo S. Double bundle anterior cruciate ligament reconstruction: Failure rate and patients-reported outcomes at 4-11 years of follow up. J Orthop. 2019;16(3):224–9.
30. Babbie ER. Survey research methods. Wadsworth Pub. Co; 1973. 383 p.