Anatomic and nonanatomic double-bundle anterior cruciate ligament reconstruction: An in vivo kinematic analysis

Stefano Zaffagnini, Giulio Maria Marcheggiani Muccioli, Cecilia Signorelli, Nicola Lopomo, Alberto Grassi, Tommaso Bonanzinga, Marco Nitri, Maurilio Marcacci

Research output: Contribution to journalArticlepeer-review


Background: There have been no direct in vivo biomechanical comparisons performed between an anatomic double-bundle (ADB) and a nonanatomic double-bundle (NADB) anterior cruciate ligament (ACL) reconstruction. Hypothesis: There are differences in kinematic outcomes between ADB and NADB ACL reconstruction techniques. Study Design: Controlled laboratory study. Methods: Twenty-six consecutive patients (mean age, 30 years; range, 18-32 years; 23 men, 3 women; 17 right knees, 9 left knees) with an isolated ACL injury were included in the study. The first 13 consecutive patients underwent NADB reconstruction (combination of a single-bundle and an over-the-top reconstruction), and the following 13 consecutive patients were treated with an ADB approach (using 2 tibial tunnels and 2 femoral tunnels placed in the center of the native femoral and tibial insertion sites). Grafts were pretensioned at 80 N and secured with cortical fixation systems under manual maximum force tension. Standard clinical laxity and pivot-shift tests were quantified at time zero before and after ACL reconstruction by means of a surgical navigation system dedicated to kinematic assessment; displacement of the medial and lateral compartments during the tests was also analyzed. Results: The ADB-reconstructed knees showed a larger preoperative-to-postoperative difference in anterior-posterior tibial plateau displacement of the medial and lateral compartments when compared with the NADB-reconstructed knees during the internal-external rotation test at 30° of flexion (P

Original languageEnglish
Pages (from-to)708-715
Number of pages8
JournalAmerican Journal of Sports Medicine
Issue number3
Publication statusPublished - Mar 2014


  • anatomic double-bundle reconstruction
  • anterior cruciate ligament
  • computer-assisted surgery
  • laxity
  • nonanatomic double-bundle reconstruction
  • pivot shift

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Medicine(all)


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