Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective, randomize clinical study

Abstract

Anatomical observation and biomechanical studies have shown that the anterior cruciate ligament (ACL) mainly consists of two distinct bundles, the anteromedial (AM) bundle and posterolateral (PL) bundle. Conventional single-bundle ACL reconstruction techniques have focused on the restoration of the AM bundle while giving limited attention to the PL bundle. The purpose of this prospective, randomized clinical study is to compare the outcomes of ACL reconstruction when using either double-bundle or single-bundle technique and bioabsorbable interference screw fixation, and similar rehabilitation with both techniques. Sixty-five patients were randomized into either double-bundle (n = 35) or single-bundle (n = 30) ACL reconstruction with hamstring tendons and bioabsorbable screw (Hexalon, Inion Company, Tampere, Finland) fixation in both groups. The evaluation methods were clinical examination, KT-1000 arthrometer measurements, radiographic evaluation, as well as International Knee Documentation Committee and Lysholm knee scores. There were no differences between the study groups preoperatively. For an average of 14 months of follow-up (range 12-20 months), 30 patients of the double-bundle group and 29 patients of the single-bundle group were available (91%). At the follow-up, the rotational stability, as evaluated by pivot shift test, was significantly better in the double-bundle group than in the single-bundle group. However, in anterior stability of the knee, there was no significant difference between the groups. None of the patients in the double-bundle group had graft failure, while four patients in the single-bundle group had. In addition, knee scores were equal at the follow-up, and all the results were significantly better at the follow-up than preoperatively, in both groups.

Arthroscopic anatomic double bundle anterior cruciate ligament reconstruction: Our experience with follow-up of 4 years

“…[2][3][4] Several prospective clinical trials have reported significantly better outcomes in anatomic DB procedures than the SB procedures in terms of pivot shift test and anterior laxity. [5][6][7][8] Several workers have…”

A Pilot Study of Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction With Ligament Remnant Tissue Preservation

“…[11][12][13][14][15][16] On the other hand, only a clinical report 17 has introduced a remnant-preserving technique for double-bundle ACL reconstruction, in which 2 femoral tunnels and one tibial tunnel were made, although anatomic double bundle ACL reconstruction procedures have recently attracted notice because of biomechanical advantages in laboratory studies. [18][19][20][21][22][23][24][25][26][27][28] However, no previous studies have shown clinical evidence about utility of the ACL remnant tissue preservation in ACL reconstruction as of yet. To verify whether preservation of the ACL remnant tissue can really improve proprioceptive functions and enhance revascularization, we should conduct a randomized comparative trial with a sufficient number of patients to compare the 2 ACL reconstruction procedures with and without the remnant preservation in terms of proprioception and revascularization of the graft.…”

Anatomical single bundle anterior cruciate ligament reconstruction

“…Given the biomechanical advantages of performing double bundle ACL reconstruction over non-anatomic single bundle reconstruction it is not surprising that there have been numerous clinical studies comparing double and single bundle ACL reconstruction [38,[41][42][43][44][45][46][47]. Several of these reveal improved anterior and rotational stability with DB reconstruction [38,43,45,47] however many show no significant difference [42,44,46].…”

“…Jarvela reported on outcomes at 2 years reporting improved knee kinematics post operatively for DB compared with SB reconstruction [41] however Siebold compared both SB and DB reconstructions and found no advantage in using the a DB technique [45] In 2008 Meredick et al performed a meta-analysis and found no difference between SB and DB ACL reconstruction [42]. Since this meta-analysis a few studies have compared lateralized or anatomic single bundle reconstructions with double bundle.…”