single or double bundle reconstruction.
its been clear that double bundle although more anatomic does not give any added advantage as far as results are concerned. It has made us understand the kinematics better and changed the way we do single bundle. The tibial tunnel being slightly anterior and femoral tunnel being more horizontal at 930 or 230 position through a medial transportal approach helped as control pivot shift better but not lachman.After all its is pivot shift which damages the knee. Few surgeon decide on single or double bundle depending on the sixe of the foot pring . If femoral footprint is larger than 18 mm or tibial more than 12 mm a double bundle if prefered.
Bracing or no bracing
at least two recent papers are founfd no difference whether of not bracing postoperative was used. So may be execpt for the non compliant patient. bracing can be left out
Hamstring or patellar tendon.
Recent 15 year prospective studies have proven tht there are no differences in long term results. May be slightly more anterior knee pain more so kneeling pain with patellar tendon grafts..
OA after acl reconstruction
The incidence of early osteoarthritis post acl reconstruction is dependant of the meniscal and articular cartilage status than anything else. Many studies do not find deference in osteoarthritis incidence after acl reconstruction but qualify menisectomy and as a bad predictore for OA.
its been clear that double bundle although more anatomic does not give any added advantage as far as results are concerned. It has made us understand the kinematics better and changed the way we do single bundle. The tibial tunnel being slightly anterior and femoral tunnel being more horizontal at 930 or 230 position through a medial transportal approach helped as control pivot shift better but not lachman.After all its is pivot shift which damages the knee. Few surgeon decide on single or double bundle depending on the sixe of the foot pring . If femoral footprint is larger than 18 mm or tibial more than 12 mm a double bundle if prefered.
Bracing or no bracing
at least two recent papers are founfd no difference whether of not bracing postoperative was used. So may be execpt for the non compliant patient. bracing can be left out
Hamstring or patellar tendon.
Recent 15 year prospective studies have proven tht there are no differences in long term results. May be slightly more anterior knee pain more so kneeling pain with patellar tendon grafts..
OA after acl reconstruction
The incidence of early osteoarthritis post acl reconstruction is dependant of the meniscal and articular cartilage status than anything else. Many studies do not find deference in osteoarthritis incidence after acl reconstruction but qualify menisectomy and as a bad predictore for OA.
Interestingly a meta analysis by the biggest proponent, Freddie Fu and Mo bhan, favours a double bundle. But many level 1 trials find no diff between single and double bundle. Off late, meta analysis interpretation has become skewed, because of addition of poor quality studies from less known journals.
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