single, double & triple bundles, footprints, …double vs single-bundle • db improves...
TRANSCRIPT
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Single, Double & Triple Bundles, Footprints, Robotics: Is It Just Alphabet Soup?
Bryan Reuss, M.D.
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ACL Reconstruction
• Restore stability and
function
• Reduce chance of further
injury
• Improve chance to get back
to previous activity
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Tunnel
placement
The key is :
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Location,
Location,
Location
-Lord Samuel
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ACL Femoral
Footprint
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Tibial Footprint
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Tunnel
Malposition
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Lachman
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Lachman
(Vertical graft/AM bundle restoration)
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Lachman
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Pivot Shift
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Native ACL
Anterior translation AND Rotational control
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Single vs Double Bundle
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• Robotic studies: Double
bundle more accurately
restores knee kinematics
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Double-Bundle Reconstruction
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Triple-Bundle ACL
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• MRI depiction and 3D
visualization of three ACL
bundles (Otsubo et al, Clin
Anatomy, Dec, 2016): 92%
• Radiological evidence for
the triple bundle ACL
(MacKay et al, Clin Anatomy,
2014): 20%
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Does it matter?
Chen G, Wang S. Comparison of single-bundle versus double-bundle anterior
cruciate ligament reconstruction after a minimum of 3-year follow-up: a meta-
analysis of randomized controlled trials. International Journal of Clinical and
Experimental Medicine. 2015;8(9):14604-14614.
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Double vs Single-Bundle
• DB improves rotational (and
often) anterior instability
over SB reconstruction
• Gap between the two
narrows over time
• Subjective scores (IKDC)
are inconsistent, but
generally do not show any
significant differences in the
long term
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Robotics
• Is it necessary for accurate
tunnels?
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Computer-assisted planning and robot-
assisted Surgery in ACL ReconstructionPetermann et al, Op Tech Orthop, 2000
• Reliably prevented notch
and wall impingement
• Went as far as to say, “that
robot-assisted ACL recon
has become the standard
care.”
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Precision of ACL tunnel placement using traditional vs robotic techniques
Burkhart et al, Comput Aid Surg, 2001
• Robotic had more
consistent tunnels, but
overall accuracy no better
than the most experienced
surgeons
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Robotic ACL-Reconstruction
• No studies have shown
clinically significant
improvement in long term
outcomes after ACL
Reconstruction
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Robotics
• Essential….
• …or creepy?
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Summary
• Optimal outcomes derive
from optimal positioning
• Respect and achieve
anterior AND rotational
stability