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G.Ebner H.J.Eichhorn H.FettM. Strobel

T.Buchhorn

technical support H.Hoffmann

10 Years Experience

with the Double BundleReconstruction

Dr.med. Jrgen Eichhorn

J.Ludwig A.SchtzP.Angele C.Tibescu

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mentors

Werner Mller (the knee, 1982)

Thomas Rosenberg (whirlpool

discussion, 1995)

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mentors

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double bundle 3 tunnels

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Savio Woo, Andrew Amis and

navigation proves betterkinematics via double bundle

basics

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Double bundle reconstructions in Straubing

1996 106 2002 3421997 187 2003 3811998 218 2004 4551999 246 2005 4722000 267 2006 4692001 291

statistics

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n=3434

Double bundle reconstructions in Straubing

statistics

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92 % STT only

we try to leave the gracilis in function

proven better internal rotation

proprioceptive function

principles

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development steps

double bundle 3 tunnelssingle bundle 2 tunnels


1 tibia

2 femur

double bundle 4 tunnelsreplacing the AM or PL bundle in partial ruptures

double bundle 4 tunnelswith additional aperture fixation


navigated

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- thick tendon Triple-technique

- weack tendon + gracilis

inappropriate graft length

principles

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Quad Semi-T

single bundle 2 tunnels

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development steps



1 tibia

2 femur


double bundle 4 tunnelswith additional apertur fixation


navigated

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Quad Semi-T

triple channel


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development steps



1 tibia

2 femur




navigated

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more contact between bone andtendon

advantages 4Channels

compared with 3 - Channels

better individual tensioning of

each bundlehigher reduction of the internaland external tibial rotation


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additional harvesting of gracilis

implanting: 4 - Channel technique

semitendinosus

= triple or quadruple

gracilis = triple

Inappropriate graft length


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Graft can be adapted

to the patients needs


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Aesculap

position

instruments

for double bundle reconstruction since

1998

instruments

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instruments

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instruments

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instruments

i

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the principle of the disk-twister

instruments

i

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instruments

d bl b dl 4 l

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45


d bl b dl 4 t l

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10


d bl b dl 4 t l

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pressfit placement

tunnel drilling in 0.5mm steps

Bungee and windshield wiper

effect protection

preconditioning of the graft

double bundle with stress sharing

final tensioning with the twister


d bl b dl 4 t l

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anatomic reconstruction-reconstruction of the anteromedial and posterolateral bundle-reconstruction of the femoral and tibial foot prints

better femoral fixation

better stabilisation in higher degrees of flexion

and in the frontal plane

Advantages 4Channel technique

contact between bone and STT doubled


d l t t

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development steps




1 tibia

2 femur




navigated

i f t t

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Semitendinosus graft procedurearchieves excellent results...

... but

...staff and skill demanding !!!

infrastructure

TCP

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PL

AM

TCP

TCP

TCP

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TCP

TCP

TCP

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TCP

TCP

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TCP

tibial femoral

TCP

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TCP

infrastructure

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Extra security for

intermediate skills

infrastructure

development steps

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development steps




1 tibia

2 femur




navigated

anatomic situation

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anatomic situation

PCL

AM

AM

AM

AM

PL?

treatment strategy

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treatment strategy

AM

AM

AM

AM

K-WIRE

PL

PASSINGSUTURE

clinics

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AM-bundle

intact

KT 1000 < 3mm

pos. pivot shift

PL-bundle

intactKT 1000 > 4mm

neg. pivot shift

clinics

development steps

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development steps




1 tibia

2 femur




navigated

double bundle navigated

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navigation avoids extensive

notch debridement

aiming without direct vision


navigated stability-test

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benefit documentation

of double bundle (AM, PL)reconstruction


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internal rotation 20

reduction via single bundle 6 (+/- 2,4) app 30%

reduction via double bundle 14 (+/- 3,1) app 70%



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IR



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external rotation 14

reduction via single bundle 3 (+/- 1,2) app 20%

reduction via double bundle 8 (+/- 1,4) app 57%



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ER


Navigated double bundle

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actual status

Navigated anteromedial bundle

Posterolateral bundle in relationshipto the anteromedial


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Future perspective

Individual navigation process foreach tunnel

results

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8-Year Quad Semi-t Results

Double-bundle vs. Single-bundle

esu ts

8 years quad semi-t results

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4 groups

isolated ACL

ACL + associated lesions

Single channel:

4863

y q

1

2


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4 groups

isolated ACL

ACL associated lesions

Double channel:

time 03. 96 - 11. 96

1 surgeon

7182

y q

3

4


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associated lesions

II MCL

II PLRI

III - IV cartilage lesion

loss of meniscus

y q


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group 1 year

0 10 15 17 14 2 3 1 1

-2 -1 0 1 2 3 4 5 > 5

89%

(1 channel- ACL + assoc. lesion.)

y q

2


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group 8 years

0 8 14 16 14 3 4 2 2

-2 -1 0 1 2 3 4 5 > 5

83%

(1 channel- ACL + assoc. lesion.)

y q

2


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group 1 year

2 19 18 27 9 2 1 2 1

-2 -1 0 1 2 3 4 5 > 5

91%

(2 channel + assoc. lesions)

y q

4


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group 8 years

2 18 19 27 10 2 2 2

-2 -1 0 1 2 3 4 5 > 5

90%

(2 channel + assoc. lesions)

y q

4

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Thank You for

Your Attention !

0- 10 years db

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