Background: Double-bundle ACL reconstruction popularity is increasing with the aim to reproduce native ACL anatomy and improve ACL reconstruction outcome. However, to date, only a few randomized clinical studies have been published. Purpose: The aim of this study was to prospectively compare the clinical results of single- and double-bundle ACL reconstruction. Study Design: Randomized controlled clinical trial; Level of evidence, 1. Methods: Seventy patients with a chronic unilateral ACL rupture who underwent arthroscopically assisted ACL reconstruction using a hamstring graft were randomized to receive a single- (SB) or double-bundle (DB) reconstruction. Both groups were comparable with regard to preoperative data. A double-incision surgical technique was adopted in both groups. The graft was fixed by looping the hamstring tendons around a bony (DB) or a metallic (SB) bridge on the tibial side and with interference screws reinforced with a staple on the femur. The same rehabilitation protocol was adopted. Outcome assessment was performed by a blinded, independent observer using the visual analog scale (VAS) score, the new International Knee Documentation Committee (IKDC) form, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and KT-1000 arthrometer evaluation. Results: All the patients reached a minimum follow-up of 2 years. No differences between the 2 groups were observed in terms of KOOS and IKDC subjective score. A statistically significant difference in favor of the DB group was found with the VAS (P < .03). The objective IKDC final scores showed statistically significantly more “normal knees” in the DB group than in the SB group (P = .03). There was 1 stability failure in the DB group and 3 in the SB group. The KT-1000 arthrometer data showed a statistically significant decrease in the average anterior tibial translation in the DB group (1.2 mm DB vs 2.1 mm SB; P < .03). The incidence of a residual pivot-shift glide was 14% in DB and 26% in SB (P = .08). Conclusion: In the 2-year minimum follow-up, DB ACL reconstructions showed better VAS, anterior knee laxity, and final objective IKDC scores than SB. However, longer follow-up and accurate instrumented in vivo rotational stability assessment are needed.

Double-bundle anterior cruciate ligament (ACL) reconstruction is intended to replicate the anatomy and the function of the anteromedial and posterolateral bundles of the native ACL to improve patients' satisfaction and knee stability. We prospectively assigned 75 consecutive patients with an isolated ACL lesion to one of three sequential groups of 25 patients each. Group I received a single-bundle, single-incision transtibial ACL reconstruction. Groups II and III received a double-bundle reconstruction with a single-incision transtibial technique or a double-bundle, twoincision outside-in technique, respectively. We obtained subjective International Knee Documentation Committee and Knee Injury and Osteoarthritis Outcome Score evaluations and objective International Knee Documentation Committee scores and KT-1000 measurements preoperatively and at followup. All patients reached a minimum followup of 2 years. KT side-to-side difference in Groups I, II, and III were 2.4, 1.6 and 1.4 mm, respectively. Group III had fewer patients with a positive pivot shift than Group I. The double-bundle double-incision outside-in ACL reconstruction resulted in improved anteroposterior stability and less residual pivot shift than single-incision single-bundle technique.

We compared short-term clinical results of the mini-subvastus approach with the standard parapatellar approach for total knee arthroplasty. Can one gain adequate access through the mini-subvastus approach without exceeding operating time, incurring additional complications, and maintaining correct implant geometry? In a prospective, observer-blinded study, 120 consecutive patients having total knee arthroplasty were operated on by one surgeon using either the mini-subvastus approach without patella eversion or the standard parapatellar approach with patella eversion. Patients were matched according to age, gender, body mass index, knee flexion, deformity, and pre-existing high tibial osteotomy. The mini-subvastus approach was technically more demanding. Reduced access and visibility prolonged the tourniquet time by an average of 15 minutes and led to two intraoperative complications. Patients in the mini-subvastus group lost on average 100 mL less blood and had better pain scores on day one [visual analogue scale (VAS): mean 2.4 versus 3.89]. They reached 90° knee flexion earlier (2.8 versus 4.5 days), and an active straight-leg raise earlier (3.2 versus 4.1 days). Their average flexion at 30, 60 and 90 days was slightly better (100°, 110°, and 112° versus 94°, 106°, and 109°). All patients including those with complications had good results with good component geometry and leg alignment. The mini-subvastus approach offers early but short-lived benefits for patients at the expense of a longer operation and a higher risk of complications. Level of Evidence: Therapeutic study, Level II-1 (prospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.

Current evidence suggests a complex interaction between adipokines and microRNA (miRNA) in osteoarthritis (OA) pathogenesis. The present study explored the role of miR-34a and miR-181a in regulating apoptosis and oxidative stress induced by visfatin in human OA chondrocytes. Chondrocytes were transfected with miR-34a and miR-181a inhibitors and stimulated with visfatin for 24 h, in the presence of nuclear factor (NF)-κB inhibitor (BAY-11-7082, 2 h pre-incubation). Apoptosis and reactive oxygen species (ROS) production were detected by cytometry, miRNA, antioxidant enzymes, nuclear factor erythroid (NRF)2 and B-cell lymphoma (BCL)2 expressions by quantitative real time polymerase chain reaction (real time PCR) and western blot. P50 NF-κB subunit was measured by immunofluorescence. Visfatin significantly induced apoptosis and superoxide anion production, increased miR-34a, miR-181a, superoxide dismutase (SOD)-2, catalase (CAT), NRF2 and decreased BCL2 gene and protein expression in OA chondrocytes. All the visfatin-caused effects were suppressed by using miR-34a and miR-181a inhibitors. Pre-incubation with BAY-11-7082 counteracted visfatin-induced expression of miRNA, BCL2, SOD-2, CAT and NRF2. Inhibition of miR-34a and miR-181a significantly reduced the activation of p50 NF-κB. Visfatin confirms its ability to induce apoptosis and oxidative stress in human OA chondrocytes; these effects appeared mediated by miR-34a and miR-181a via NF-κB pathway. We highlight the relevance of visfatin as potential therapeutic target for OA treatment.