Prospective randomized comparison of anatomic single- and double-bundle anterior cruciate ligament reconstruction

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2014-02, Vol.22 (2), p.308-316
• Main Authors: Xu, Yan, Ao, Ying-fang, Wang, Jian-quan, Cui, Guo-qing
• Format: Article
• Language: English
• Subjects: Adult; Anterior Cruciate Ligament - anatomy & histology; Anterior Cruciate Ligament - surgery; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction - methods; Arthroscopy; Cartilage; Female; Follow-Up Studies; Humans; Knee; Knee Injuries - physiopathology; Knee Injuries - surgery; Knee Joint - physiology; Knee Joint - surgery; Ligaments; Male; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Prospective Studies; Treatment Outcome
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-013-2398-y

Purpose To determine if anatomic double-bundle anterior cruciate ligament (ACL) reconstruction is superior to anatomic single-bundle reconstruction in restoring the stabilities and functions of the knee joint. Methods A prospective randomized clinical study was done to compare the results of 32 cases of anatomic single-bundle ACL reconstruction and 34 cases of anatomic double-bundle ACL reconstruction with average follow-up of 16.3 ± 3.1 months. Tunnel placements of all the cases were measured on 3D CT. Clinical results were collected after reconstruction; graft’s appearance, meniscus status and cartilage state under arthroscopy were compared and analysed too. Results Tunnel placements, confirmed with 3D CT, were in the anatomic positions as described in literature both in SB and DB group. No differences were found between SB and DB groups in clinical outcome scores, pivot shift test and KT 1000 measurements (average side-to-side difference for anterior tibial translation was 0.7 mm in SB group and 1.0 mm in DB group). More than 70 % of the single-bundle graft and AM bundle graft in DB group appeared excellent, but only 44.1 % of PL bundle grafts in DB group were excellent and 11.8 % were in poor state. No new menisci tear was found either in SB or DB group, however, in DB group cartilage damages in medial patella-femoral joint occurred in 38.2 % cases. This rate was significantly higher than in the SB group which is only 9.3 %. Conclusion Both single- and double-bundle anatomic ACL reconstruction can restore the knee’s stability and functions very well. However, more incidences of poor PL status and medial patellar-femoral cartilage damage may occur in double-bundle ACL reconstruction. Level of evidence Randomized controlled trial, Level I.