Single Bundle Versus Double Bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis,Indian Journal of Orthopaedics

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Single Bundle Versus Double Bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis
Indian Journal of Orthopaedics ( IF 1.1 ) Pub Date : 2022-08-29 , DOI: 10.1007/s43465-022-00718-0
Mohammed S Alomari _{1,

2} , Abdullah A Ghaddaf _{1,

2} , Ahmed S Abdulhamid _{1,

2} , Mohammed S Alshehri _{1,

2,

3} , Mujeeb Ashraf ₄ , Hatem H Alharbi ₄

Affiliation

Background

Anterior cruciate ligament (ACL) tear is considered as one of the most common sport-related musculoskeletal injuries. Double bundle (DB) and single bundle (SB) surgical techniques has been widely adopted for ACL reconstruction. This systematic review aimed to provide updated evidence by comparing the short-term, mid-term, and long-term knee stability and functional outcomes of DB and SB reconstruction techniques.

Methods

We searched Medline, Web of Science, and CENTRAL. We have selected randomized controlled trials (RCTs) that compared DB and SB ACL reconstruction techniques for primary isolated ACL tear. We have assessed the following outcomes: pivot shift test, Lachman test, KT-1000/2000 knee ligament arthrometer, Lysholm knee function score, Tegner activity score, and graft failure. We have used the standardized mean difference (SMD) was to summarize the continuous outcomes while risk ratio (RR) was used to summarize the dichotomous outcomes.

Results

A total of 34 RCTs that enrolled 2,992 participants deemed eligible. Overall, DB showed significantly better outcomes in terms of pivot shift test (RR = 0.61, 95% confidence interval (CI) 0.49–0.75), Lachman test (RR = 0.77, 95% CI 0.62 to 0.95), and KT 1000/2000 arthrometer (SMD = − 0.21, 95% CI − 0.34 to − 0.08). No discernible difference was found between DB and SB techniques in the overall Lysholm score (SMD = 0.12, 95% CI − 0.03 to 0.27), Tegner score (SMD = 0.03, 95% CI − 0.17 to 0.24), or graft failure rate (RR = 0.78, 95% CI 0.33 to 1.85).

Conclusions

Our review suggests that DB ACL reconstruction technique shows significantly better knee stability and functional outcomes than SB at short-term follow-up. However, both techniques exhibit similar outcomes at mid-term and long-term follow-up.

中文翻译：

单束与双束前十字韧带重建：系统评价和荟萃分析

背景

前十字韧带（ACL）撕裂被认为是最常见的运动相关肌肉骨骼损伤之一。双束（DB）和单束（SB）手术技术已广泛用于ACL重建。本系统综述旨在通过比较 DB 和 SB 重建技术的短期、中期和长期膝关节稳定性和功能结果来提供最新证据。

方法

我们检索了 Medline、Web of Science 和 CENTRAL。我们选择了随机对照试验 (RCT)，比较 DB 和 SB ACL 重建技术治疗原发性孤立性 ACL 撕裂的情况。我们评估了以下结果：枢轴移位测试、Lachman 测试、KT-1000/2000 膝关节韧带关节计、Lysholm 膝关节功能评分、Tegner 活动评分和移植失败。我们使用标准化均差（SMD）来总结连续结果，而使用风险比（RR）来总结二分结果。

结果

共有 34 项随机对照试验纳入了 2,992 名被认为符合资格的参与者。总体而言，DB 在枢轴移位检验（RR = 0.61，95% 置信区间 (CI) 0.49–0.75）、Lachman 检验（RR = 0.77，95% CI 0.62 至 0.95）和 KT 1000/2000 方面显示出明显更好的结果关节计（SMD = − 0.21，95% CI − 0.34 至 − 0.08）。DB 和 SB 技术在总体 Lysholm 评分（SMD = 0.12，95% CI - 0.03 至 0.27）、Tegner 评分（SMD = 0.03，95% CI - 0.17 至 0.24）或移植失败率（ RR = 0.78，95% CI 0.33 至 1.85）。