Remnant‐Tensioning Single‐Bundle Anterior Cruciate Ligament Reconstruction Provides Comparable Stability to and Better Graft Vascularity Than Double‐Bundle Anterior Cruciate Ligament Reconstruction in Acute or Subacute Injury: A Prospective Randomized Controlled Study Using Dynamic Contrast‐Enhanced Magnetic Resonance Imaging

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Abstract
Purpose: To compare the clinical, second‐look arthroscopic, magnetic resonance imaging (MRI), and dynamic‐contrast‐enhanced MRI (DCE‐MRI) findings between remnant‐tensioning single‐bundle (RT‐SB) and double‐bundle (DB) anterior cruciate ligament reconstruction (ACLR). Methods: Sixty‐seven patients with acute or subacute anterior cruciate ligament (ACL) injury were randomized to undergo RT‐SB or DB ACLR. Twenty‐six patients in the RT‐SB group and 28 in the DB group were evaluated using stability tests (Lachman test, pivot‐shift test, and KT‐2000 arthrometer) and multiple clinical scores. One year postoperatively, all 54 patients underwent MRI for evaluation of graft continuity and graft signal/noise quotient and DCE‐MRI for the calculation of normalized area under the curve (nAUC) as a marker of graft vascularity. Among them, 41 patients underwent second‐look arthroscopy for the evaluation of graft continuity, graft tension, and synovialization. The results were compared between the 2 groups. Results: At the minimum 2‐year follow‐up (28.7 ± 6.4 months), the stability tests, clinical scores, second‐look arthroscopic findings, and MRI findings were not significantly different between the groups. However, the mean nAUC values on DCE‐MRI for the ACL graft were significantly higher in the RT‐SB group than those in the DB group in all 3 zones (nAUC proximal , P = .005; nAUC middle , P = .021; nAUC distal , P = .027; and nAUC average , P = .008). Conclusion: For acute or subacute ACL injury, the RT‐SB ACLR showed an outcome comparable to that of DB ACLR in terms of knee stability, clinical scores, MRI findings, and second‐look arthroscopic findings. Moreover, RT‐SB ACLR showed better graft vascularity 1 year postoperatively than DB ACLR using DCE‐MRI. Level of Evidence: II, prospective randomized controlled trial
Funding Information
  • H2020 LEIT Information and Communication Technologies
  • National Research Foundation of Korea (NRF-2017R1A2B3007362)
  • National Research Foundation of Korea

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