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Single Bundle Versus Double Bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

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Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

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.

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Abbreviations

ACL:

Anterior cruciate ligament

DB:

Double bundle technique

SB:

Single bundle technique

RCT:

Randomized controlled trial

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analysis

IKDC:

International Knee Documentation Committee score

CENTRAL:

Cochrane Central Register of Controlled Trials

SMD:

Standardized mean difference

RR:

Risk ratio

OA:

Osteoarthritis

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Authors and Affiliations

  1. College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia

    Mohammed S. Alomari, Abdullah A. Ghaddaf, Ahmed S. Abdulhamid & Mohammed S. Alshehri

  2. King Abdullah International Medical Research Center, Jeddah, Saudi Arabia

    Mohammed S. Alomari, Abdullah A. Ghaddaf, Ahmed S. Abdulhamid & Mohammed S. Alshehri

  3. Department of Surgery/Orthopedic Section, King Abdulaziz Medical City, Jeddah, Saudi Arabia

    Mohammed S. Alshehri

  4. Department of Surgery/Orthopedic Section, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia

    Mujeeb Ashraf & Hatem H. Alharbi

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Correspondence to Abdullah A. Ghaddaf.

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Alomari, M.S., Ghaddaf, A.A., Abdulhamid, A.S. et al. Single Bundle Versus Double Bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. JOIO 56, 1669–1684 (2022). https://doi.org/10.1007/s43465-022-00718-0

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