Prospective Randomized Comparison of
Knee Stability and Joint Degeneration for Double- and Single-Bundle ACL

R, Chen B, Wang F, Wang X, & Chen J. 
Knee Surg Sports Traumatol
2014 Published Online
First March 22, 2014: doi: 10.1007/s00167-014-2934-4

Take Home Message: Double-bundle ACL
reconstruction with allograft or autograft may be superior to single-bundle
techniques with allograft at enhancing knee stability but all three procedures
have comparable patient-reported outcomes.

anterior cruciate ligament (ACL) reconstructions being a common surgical
procedure it remains unclear which surgical technique or graft selection is
best for ACL reconstruction.  Therefore,
the purpose of this randomized trial was to investigate the stability,
functional outcomes, clinical evaluation, and radiologic outcomes among
participants who received one of three ACL reconstructions: 1) single-bundle technique
with an allograft (142 participants), 2) double-bundle technique with an
allograft (128 participants), and 3) double-bundle technique with a hamstring
autograft (154 participants).  The
authors evaluated the participants at 3, 12, and 36 months after surgery.  Both double-bundle groups had better anterior
knee stability than the single-bundle group at 12 and 36 months after surgery as
measured by KT-1000.  Similarly, more
individuals in both double-bundle groups had negative pivot-shift tests at all
follow-up time points.  Despite differences
in laxity, all three groups had similar self-reported knee symptoms and
function as measured by IKDC 2000 and
Lysholm scores.

study supports previous research that showed that the double-bundle technique
achieves better stability (anterior and rotational) than the single bundle.
This may be contributed to a more anatomic replication of the original ACL.  However, a more stable knee does not appear
to cause clinically detectable differences in symptoms or function among participants.  This also raises the question about whether the
improved stability would ward off osteoarthritis. After all, many people
function without an ACL and have comparable rates of osteoarthritis as those
with an ACL reconstruction.  The
double-bundle technique may need to be investigated further to determine if it
offers better long-term outcomes since there appears to be minimal differences
in the relatively short-term follow up.  Furthermore,
among participants who received the double-bundle technique, there were no
differences between the participants who received the autograft or allograft.  There is limited research with double-bundle allograft
techniques, and this study seems to support that it is as effective as the more
traditional double bundle with autograft selection.  This provides a nice alternative for another
graft option in a patient population that may be susceptible to complications
from the hamstring autograft harvesting as there were no differences in
clinical outcomes (e.g., Lysholm and IKDC 2000).  Interestingly, these results indicate that
the double-bundle techniques may be superior to a single bundle technique with allograft
at enhancing knee stability but all three procedures may lead to similar
patient-reported outcomes.

Questions for Discussion:  Do
you think that double-bundle technique will be more frequently chosen for ACL
Reconstruction?  Have you worked with patients
that have had a double-bundle ACL reconstruction done – and if so, are there
any clinical difference that you notice in comparison to a single bundle
by: Nicole Cattano
by: Jeffrey Driban

Related Posts:

Sun, R., Chen, B., Wang, F., Wang, X., & Chen, J. (2014). Prospective randomized comparison of knee stability and joint degeneration for double- and single-bundle ACL reconstruction Knee Surgery, Sports Traumatology, Arthroscopy DOI: 10.1007/s00167-014-2934-4