Double-bundle reconstruction results in superior clinical outcome than single-bundle reconstruction
Zhu Y, Tang R, Zhao P, Shu S, Li Y, & Li J. Knee Surgery, Sports Traumatology, Arthroscopy. 2012; doi 10.1007/s00167-012-2073-8
Injuries to the anterior cruciate ligament (ACL) often necessitate surgical reconstruction. The debate continues as to whether or not the double-bundle (DB) technique is more beneficial than the single-bundle (SB) technique. The purpose of this meta-analysis was to analyze the literature and find previous clinical trials that compared the single- and double-bundle ACL surgical reconstruction techniques. A literature search resulted in 18 trials that met the inclusion criteria (prospective, randomized studies that compared DB vs. SB and included patients over 18 years old) and not the exclusion criteria (without follow-up or had nonclinical outcomes). Included studies had 1,229 patients who received ACL reconstruction (514 DB, 715 SB). Studies that followed patients > 24 months were categorized as long-term studies and studies that followed patients < 24 months were short-term studies. Outcomes of interest were clinical (KT-1000, pivot shift, Lachman) and patient-centered outcomes (Lysholm, IKDC, Tenger activity). DB ACL reconstruction resulted in better clinical outcomes (KT-1000, Lachman, pivot shift, patient reported outcomes [IKDC]) and fewer complications than SB ACL reconstruction, however, there were no differences found in patient-reported functional capacity. These results were consistently found in the short-term and long-term studies.
Clinically, it appears that DB ACL reconstruction may be superior to SB ACL reconstruction. Although the DB technique appears to have better outcomes in clinical measures, there were no differences found in patient functional capacity. In the short-term and long-term follow-up studies, the DB had better clinical outcomes (KT-1000, Lachman, and Tenger activity) however, there were no differences in functional capacity between the groups. With this in mind, it is important to consider that DB ACL reconstructions carry the inherent risk of tunnel collapse which could result in extremely poor patient outcomes. It would be interesting to see what the failure rate of DB and SB ACL reconstructions were in the included studies. Also, as DB ACL reconstruction becomes more common, it would be interesting to follow these patients for longer than 24 months to determine longer-term outcomes. Very little is still known about the influence of SB vs. DB ACL reconstruction on the incidence of osteoarthritis, and 24 months may not be enough time to see these changes develop. This time frame is barely long enough to determine successful return to play as it typically takes an ACL patient up to 1 year until they feel “normal” upon return to play. Has anyone had any patients undergo DB ACL reconstruction? What seems to be the clinical/anecdotal evidence that you are seeing?
Written by: Nicole Cattano
Reviewed by: Jeffrey Driban
Ying Zhu, Ren-kuan Tang, Peng Zhao, Shi-sheng Zhu and Yong-guo Li, et al. (2012). Double-bundle reconstruction results in superior clinical outcome than single-bundle reconstruction Knee Surgery, Sports Traumatology, Arthroscopy DOI: 10.1007/s00167-012-2073-8