Outcome of Single-Bundle versus Double-Bundle Reconstruction of the Anterior Cruciate Ligament

Abstract

Double-bundle reconstruction does not result in clinically significant differences in KT-1000 arthrometer or pivot-shift testing. The pivot-shift results have particular clinical relevance because the test is designed to evaluate knee rotational instability; the results do not support the theory that double-bundle reconstruction better controls knee rotation. Improved quality of future RCTs would allow meta-analysis of a greater number of outcome measures including measures of symptoms and disabilities most important to patients.

The evolution of ACL reconstruction over the last fifty years

“…A meta-analysis [47] published by R. Meredick and based on four randomized studies, noted an improvement in arthrometer differentials of 0.52 mm without a statistical difference in normal or subjectively normal (pivot glide) rotary subluxation. Yasuda's 2010 publication [48], reviewed ten randomized trials comparing the single and double bundle reconstruction and showed a seven fold significantly better result in anterior laxity for the double bundle technique.…”

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.…”