Case Control Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2019; 10(12): 446-453
Published online Dec 18, 2019. doi: 10.5312/wjo.v10.i12.446
Anterior cruciate ligament reconstruction using a double bundle hamstring autograft configuration in patients under 30 years
Christopher Reece Lim, Tamalee Henson, Jay Ebert, Peter Annear
Christopher Reece Lim, Department of Orthopaedics, Sir Charles Gairdner Hospital, Western Australia, Nedlands 6009, Australia
Tamalee Henson, Fiona Stanley Hospital, Western Australia, Murdoch 6150, Australia
Jay Ebert, School of Human Sciences (Exercise and Sport Science), University of Western Australia, Western Australia, Crawley 6009, Australia
Peter Annear, Perth Orthopaedic and Sports Medicine Centre, Western Australia, West Perth 6005, Australia
Author contributions: Lim CR is primary author, responsible for data collection and interpretation of results, writing of the manuscript and editing of the manuscript. Ebert J was responsible for interpretation of results and editing of the manuscript. Henson T contributed to data collection. Annear P was responsible for development of the original idea, interpretation of the results and editing of the manuscript.
Institutional review board statement: Attached is a copy of the ethics approval granted for the purpose of this study in 2015 which was originally written in the English language.
Informed consent statement: Attached is a copy of the patient consent forms used for the study which was originally written in the English language.
Conflict-of-interest statement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Data sharing statement: Technical appendix, statistical code, and datasets are available from the corresponding author at christopherlim22@gmail.com. Consent was not obtained but the presented data are anonymized and risk of identification is low.
STROBE statement: The guidelines of the STROBE Statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Christopher Reece Lim, BSc, MBBS, Doctor, Medical Doctor, Department of Orthopaedics, Sir Charles Gairdner Hospital, Hospital Ave, Western Australia, Nedlands 6009, Australia. christopherlim22@gmail.com
Telephone: +61-43-2835277
Received: January 14, 2019
Peer-review started: January 14, 2019
First decision: March 15, 2019
Revised: April 4, 2019
Accepted: September 22, 2019
Article in press: September 22, 2019
Published online: December 18, 2019
Processing time: 331 Days and 17.9 Hours
ARTICLE HIGHLIGHTS
Research background

Anterior cruciate ligament reconstruction (ACLR) is a common procedure in the young active population. Current re-rupture rates in single bundle techniques have been quoted as high as 20%-30%. While studies have shown that there are similar functional outcomes between single and double bundle ACL reconstruction techniques the re-rupture rates have not been well reported.

Research motivation

This body of research aims to investigate if double bundle ACL reconstruction techniques have lower re-rupture rates in comparison to single bundle ACL reconstruction.

Research objectives

The main objective of this research was to compare re-rupture rates of single bundle and double bundle ACL reconstruction in the young, active population. If re-rupture rates are suggestive of being lower, more research, such as a randomized control trial between the two techniques could be done to further assess the viability of double bundle ACL reconstruction, specifically in these patients.

Research methods

All patients under the age of 30 years old who underwent a double bundle ACL reconstruction at a single orthopedic clinic were assessed for eligibility for the study. Of the 112 patients, 91 (81.3%) could be contacted to complete an over the phone questionnaire. Outcomes assessed included the incidence (and timing) of subsequent re-tear and contralateral ACL tear, further surgeries, incidence and time to return to sport, and patient satisfaction. Chi-Squared tests (P < 0.05) were then used to compare the population in this study and a recent study by Webster et al[2], looking at re-rupture rates in single bundle ACL reconstructions from a similar population.

Research results

Six of the 91 patients enrolled in the study suffered from re-rupture (6.6%, 95%CI, 1.4–11.7). The mean time to re-rupture was 28 mo (range 18-24) with an additional 14 patients (15.4%) suffering from a contralateral ACL tear in the follow-up period. 14 patients (15.4%) required further surgery to their ipsilateral knee. 50 patients (54.9%) managed to return to their pre-injury level of sport, unfortunately, none of the professional level athletes returned o profession level sport. 1 patient who played amateur level netball did go on to play at a professional level with their double bundle ACL reconstruction. Comparative analysis of re-rupture rates with the Webster et al[2] paper, that investigated single bundle ACL reconstructions revealed a non-significant chi-squared statistic of 2.348 (P = 0.125).

Research conclusions

Double bundle re-rupture rates are low (6.6%). However, while there was a trend towards lower re-rupture rates in the double bundle ACL reconstruction population, there was no statistical significance in comparative testing when compared with a single bundle ACL reconstruction cohort. Double Bundle ACL reconstruction may have lower re-rupture rates that single bundle techniques but further research needs to be done to investigate these theories. The risk of re-rupture with double bundle ACL reconstruction is low in the young, active population. When compared with single bundle ACL reconstruction techniques, double bundle reconstructions have at least comparable re-rupture rates. Further research is needed to fully investigate the re-rupture rate differences between these two techniques. There is a significant paucity of knowledge regarding double bundle ACL reconstruction outcomes, with few studies investigating re-rupture rates in the young, active population. Double bundle ACL reconstruction has lower re-rupture rates than single bundle ACL reconstruction in the young, active population. Double bundle ACL reconstruction could be considered as a technique to adopt in high risk, young, active patients. Double bundle reconstructions have low re-rupture rates in the young, active, population. These rates are at least comparable with current single bundle ACL reconstruction re-rupture rates. The hypothesis that double bundle ACL reconstructions would have lower re-rupture rates in the young, active population when compared with single bundle techniques was not proven in this study. However statistical analysis reported no significant difference between the two techniques with regard to re-rupture rate. Double bundle ACL reconstruction could be considered as a technique for young, active patients with ACL tears looking for repair.

Research perspectives

Double bundle ACL reconstruction could be considered as technique in young, active patients with ACL tears looking for repair. Further research is required to investigate more deeply the differences in outcomes (in particular re-rupture rates) between these two techniques in the young, active population. A randomized control trial looking at the two techniques, double bundle vs single bundle ACL reconstruction, would provide the highest level of evidence.