Double-bundle Anterior Cruciate Ligament reconstruction: a review of literature

Abstract

Purpose Anterior cruciate ligament (ACL) reconstruction has been under intensive discussion and debate, although the anatomy of this ligament was resolved thoroughly almost 200 years ago. The ACL consist of two bundles, anteromedial (AM) and posterolateral (PL). The conventional single-bundle method reconstructs the AM bundle only, while the modern double-bundle technique recreates both bundles for their anatomical sites. Methods An English language literature search was undertaken over the years 2000-2012 for ACL reconstruction, double-bundle versus single bundle technique. The search found 14 RCTs and two meta-analyses published to date. Results Two of the 14 studies (14 %) showed no difference between the two reconstruction methods while the remaining majority (12 trials, 86 %) concluded that the DB technique was better than the SB method. After the DB reconstruction, rotational stability of the knee was better in seven studies (50 %) and anteroposterior stability in six (43 %). No study spoke for the single-bundle technique. In addition, with the double-bundle technique knee scores were reported to be better in five (36 %) studies, and three trials (21 %) revealed less reoperations in the double-bundle group. Conclusions The double-bundle ACL reconstruction technique was reported to have better or at least the same results as the conventional single-bundle method-even at a fiveyear follow-up. However, the majority of these studies had a rather short follow-up, and thus, longer studies are needed to confirm the true long-term results of ACL surgery. Long follow-up periods are also needed to find out whether double-bundle ACL reconstruction can eventually prevent knee osteoarthritis.

No Difference in the KOOS Quality of Life Subscore Between Anatomic Double-Bundle and Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction of the Knee: A Prospective Randomized Controlled Trial With 2 Years’ Follow-up

“…Girgis et al were one of the first to describe the different tension patterns between the bundles during knee motion. 50 They found that the AM-bundle was tight during flexion and the remaining ACL-tissue (PL-bundle), tight in extension. 50 Later, techniques to measure direct, resultant, in situ forces within the native ACL were developed.…”

Different Techniques of ACL Reconstruction: Guidelines

“…This technique is the so-called double-bundle ACL reconstruction . Two recent meta-analyses showed that the AP and rotational stability are better with a double-bundle reconstruction compared to single-bundle reconstruction (Suomalainen et al 2012;Tiamklang et al 2012). Moreover, there is limited evidence for a lower rerupture rate and a lower incidence of meniscal tears after double-bundle reconstruction than after single-bundle reconstruction (Suomalainen et al 2012;Tiamklang et al 2012).…”

“…Two recent meta-analyses showed that the AP and rotational stability are better with a double-bundle reconstruction compared to single-bundle reconstruction (Suomalainen et al 2012;Tiamklang et al 2012). Moreover, there is limited evidence for a lower rerupture rate and a lower incidence of meniscal tears after double-bundle reconstruction than after single-bundle reconstruction (Suomalainen et al 2012;Tiamklang et al 2012). A recent study, however, has shown that the personalized use of both techniques (small insertion zones, single bundle; large insertion zones, double bundle) resulted in no difference between the two techniques with regard to stability and clinical scores (Hussein et al 2012).…”

Surgical and Biomechanical Perspectives on Osteoarthritis and the ACL Deficient Knee: A Critical Review of the Literature

“…concluded that after double bundle reconstruction, rotational stability of the knee was better in 7 (50%) studies, and anterior-posterior stability in 6 (43%) [76]. The review also noted that knee scores were better in 5 (36%) and that 3 trials (21%) revealed less re-operation rates compared with single bundle reconstruction [76]. …”