Cochrane in CORR ®: Double-bundle Versus Single-bundle Reconstruction for Anterior Cruciate Ligament Rupture in Adults (Review)

Clinical Outcome Evaluation of Anatomic Anterior Cruciate Ligament Reconstruction With Tunnel Positioning Using Gold Standard Techniques: A Systematic Review and Meta-analysis

“…14,34,44 When the posterior bundle is reconstructed, there is theoretical benefit of improved rotational stability, but recent studies have indicated that despite requiring more surgical time and greater technical difficulty, 6 ADB ACL reconstruction does not result in superior clinical and functional outcomes compared with ASB ACL reconstruction (when grafts are placed at the center of the anatomic position and the femoral tunnel is lower than it is when the standard technique is used). 17,24,27 In the present systematic review, there was no significant superiority of the ASB or ADB technique over the other. A considerable amount of research has been published in the past few decades comparing ADB with ASB ACL reconstruction techniques, and other systematic reviews have been published on this topic.…”

“… 14 , 34 , 44 When the posterior bundle is reconstructed, there is theoretical benefit of improved rotational stability, but recent studies have indicated that despite requiring more surgical time and greater technical difficulty, 6 ADB ACL reconstruction does not result in superior clinical and functional outcomes compared with ASB ACL reconstruction (when grafts are placed at the center of the anatomic position and the femoral tunnel is lower than it is when the standard technique is used). 17 , 24 , 27 …”

“…The meta-analysis by Björnsson et al 3 did not show superiority of the technique in clinical evaluation at short- and long-term follow-ups, such as the preoperative level and performance of return to sports activity. In a meta-analysis, van Eck et al 43 presented positive results for double-bundle reconstruction for anterior and rotational laxity, assessed using arthrometer and physical examination (Lachman and pivot-shift tests), while Mundi and Bhandari 27 showed faster return to the sports and a reduced risk of new ACL injuries. However, even when the comparison between ADB and ASB techniques showed significant differences in prospective studies, they were limited to objective evaluations because in the postoperative period, patients had similar opinions regardless of the surgical technique, as exemplified in the study by Kondo et al 19 according to Massey et al, 25 in which the patients had superior results in ADB reconstruction via the KT-2000 arthrometer but no statistically different scores, such as the IKDC subjective.…”

The Fragility of Statistically Significant Findings From Randomized Trials in Sports Surgery: A Systematic Survey

“…11 Meta-analyses of many common orthopaedic interventions, including trials of sports medicine, also have found no difference between many comparator groups, potentially due to widespread deficiencies such as small sample sizes and potential risk of bias. 7,12,25…”

“…Similar to the literature in spine surgery, trials in orthopaedic sports medicine and arthroscopic surgery have generally been of small sample sizes, have been at increased risk for bias, and generally have few outcome events. 13,19 The median sample size in our survey was 64 patients (IQR, 48.5-89.5), and the median total number of events for each outcome was 19 (IQR, [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. This contrasts significantly with the findings by Walsh et al 31 of 399 RCTs published in high-impact medical journals, which found a median sample size of 682 patients (range, 15-112,604) and a median number of events per outcome of 112 (range, 8-5142).…”