Single- versus Double-bundle ACL Reconstruction: Is There Any Difference in Stability and Function at 3-year Followup?

Abstract

Background Despite a number of studies comparing postoperative stability and function after anatomic doublebundle and single-bundle anterior cruciate ligament reconstruction (ACLR), it remains unclear whether double-bundle reconstruction improves stability or function. Questions/purposes We therefore asked whether patients having single-and double-bundle ACLR using semitendinosus (ST) alone differed with regard to (1) postoperative stability; (2) ROM; and (3) five functional scores. Methods We prospectively followed 60 patients with an isolated anterior cruciate ligament (ACL) injury. Thirty patients underwent single-bundle and 30 patients underwent double-bundle ACL reconstruction. Clinically we assessed stability and range of motion (ROM); anteroposterior stability was assessed by Rolimeter and rotational stability by a pivot shift test. Function was assessed by IKDC, Noyes, Lysholm, Marx, and Tegner activity scales.The minimum followup was 36 months (mean, 46.2 months; range, 36-60 months). Results Residual anteroposterior laxity at 3 years postoperatively was similar in both groups: 1.4 ± 0.3 mm versus 1.4 ± 0.2 mm, respectively. We observed no difference in the pivot shift test. ROM was similar in both groups, although double-bundle patients required more physical therapy sessions to gain full ROM. IKDC, Noyes, Lysholm, Marx, and Tegner scores were similar at final followup. Conclusion Double-bundle reconstruction of the ACL did not improve function or stability compared with singlebundle reconstruction.

Does Double-Bundle Anterior Cruciate Ligament Reconstruction Improve Postoperative Knee Stability Compared With Single-Bundle Techniques? A Systematic Review of Overlapping Meta-analyses

“…Desai et al 20 Zhu et al 12 Kongtharvonskul et al 19 Li et al 18 (2013) Xu et al 13 Tiamklang et al 15 van Eck et al 14 Meredick et al 16 Gobbi, 2012 28 þ þ À À À þ À À À Hussein, 2012 29 À þ À À þ þ À À À Lee, 2012 30 À þ À À þ À À À À Nuñez, 2012 31 À À À À þ À À À À Ochiai, 2012 32 À À À À þ À À À À Lee, 2012 33 þ À À À À À À À À Suomalainen, 2012 34 À þ À À À À À À À Araki, 2011 35 À þ þ þ þ þ þ À À Fujita, 2011 36 þ þ þ À À þ À À À Hemmerich, 2011 37 À þ þ À þ À À À À Kyoung, 2011 38 þ À À À À À À À À Misonoo, 2011 39 À þ À þ À À þ À À Plaweski, 2011 40 À þ À À À À À À À Siebold, 2011 41 þ À À À À À À À À Stefani, 2011 42 þ À À À À À À À À Suomalainen, 2011 43 þ…”

Can the pivot-shift be eliminated by anatomic double-bundle anterior cruciate ligament reconstruction?

“…The median sample size was 10 (range, [8][9][10][11][12][13][14] cases for in vitro studies and 30 (range, 21-90) cases for in vivo studies. The average age of subjects was 60.7 (median, 62; range, 31-72) years for in vitro studies and 28.6 (median, 29; range, 12-50) years for in vivo studies.…”

“…Using a manual PS test some clinical studies showed superior rotational laxity control of the knee after DB compared with SB ACL reconstruction [15,32,33,39], while other studies reported similar results in both techniques [10,27].…”

Double-bundle depiction of the anterior cruciate ligament at 3 Tesla

“…In addition, surgical techniques might not have been sufficiently developed yet as some recent studies did not show a significant clinical benefit between singlebundle ACL reconstruction technique and double-bundle ACL reconstruction technique [12,13].…”