reconstruction results in superior clinical outcome than single-bundle

Y, Tang R, Zhao P, Shu S, Li Y, & Li J. Knee Surgery, Sports Traumatology,
Arthroscopy. 2012; doi 10.1007/s00167-012-2073-8

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.

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?

by: Nicole Cattano
by: Jeffrey Driban

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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