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Comparison of single-bundle, double-bundle PCL cases shows both techniques are comparable

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WASHINGTON — Investigators reported that there is no advantage to using the single-bundle arthroscopic transtibial PCL reconstruction technique vs. the double-bundle approach, according to results collected at 15 to 72 months postsurgery.

In a retrospective study presented here at the 27th Annual Meeting of the Arthroscopy Association of North America, Gregory C. Fanelli, MD, and colleagues compared the results of 90 consecutive arthroscopic transtibial PCL reconstructions he performed using either a single-bundle or double-bundle technique. The single-bundle and double-bundle groups each consisted of 45 patients and included both PCL collateral and PCL-ACL collateral cases.

A comparison of all single-bundle and double-bundle procedures using stress X-rays showed a mean side-to-side difference of 2.56 mm in the single-bundle group and 2.36 mm in the double-bundle cohort. An analysis of all patients who underwent the PCL collateral procedure revealed a mean side-to-side difference of 2.59 mm for the single-bundle group and 1.85 mm for the double-bundle group.

In addition, PCL-ACL collateral patients in the single-bundle group showed a side-to-side difference of 2.53 mm vs. 3.16 mm in the double-bundle group. Postoperative evaluations using stress X-ray, KT-1000, Lysholm, Tegner and HSS scales also showed no clear advantage to either technique.

"My conclusion is that both techniques provide successful results," Fanelli said during his presentation. "Both the single and double-bundle groups had an average of 3 mm side-to-side difference on Telos stress radiography. Neither the single-bundle nor double-bundle approaches appear to be superior to the other on evaluation with stress X-ray, KT 1000 or any of the other rating scales."

He added, "I think that if we identify acute pathology, use strong graft material, put the tunnels in the right place, use anatomic graft insertion sites, minimize graft bending, use mechanical tension with good fixation and [have patients participate in] the appropriate rehab program, both methods will create successful PCL reconstructions."

For more information:

• Fanelli GC, Edson C, Reinheimer K, et al. Arthroscopic single-bundle vs. double-bundle posterior cruciate ligament reconstruction. Paper SS46. Presented at the 27th Annual Meeting of the Arthroscopy Association of North America. April 24-27, 2008. Washington.