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First published on May 28, 2008, doi:10.1177/0363546508317964
This version was published on July 1, 2008
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The American Journal of Sports Medicine 36:1414-1421 (2008)
© 2008 American Orthopaedic Society for Sports Medicine

Winner of the 2007 Systematic Review Competition

Outcome of Single-Bundle Versus Double-Bundle Reconstruction of the Anterior Cruciate Ligament

A Meta-Analysis

Richard B. Meredick, MD*, Kennan J. Vance, DO*, David Appleby, MPH{dagger} and James H. Lubowitz, MD*,{ddagger}

From * Taos Orthopaedic Institute Research Foundation, Taos, New Mexico, and {dagger} Smith & Nephew, Andover, Massachusetts

{ddagger} Address correspondence to James H. Lubowitz, Taos Orthopaedic Institute Research Foundation, 1219-A Gusdorf Rd. Taos, NM 87571 (e-mail: jlubowitz{at}kitcarson.net).

Background: The anterior cruciate ligament (ACL) has 2 anatomic bundles. Standard ACL reconstruction is with a single-bundle graft, but double-bundle reconstruction may better control knee rotational torque, a potential cause of failure after single-bundle reconstruction. The authors investigated outcomes of single-bundle versus double-bundle ACL reconstruction.

Hypothesis: There is no difference in outcomes of single-bundle versus double-bundle reconstruction.

Study Design: Meta-analysis.

Methods: The authors systematically identified randomized controlled trials (RCTs) comparing single-bundle versus double-bundle ACL reconstruction (secondary analysis includes nonrandomized trials). Outcomes reported in a majority of included trials were meta-analyzed.

Results: Four RCTs were included (secondary analysis including 5 additional trials yielded reassuringly similar results). Two outcome measures were reported (in a manner permitting meta-analysis) in at least 3 of 4 trials: KT-1000 arthrometer and pivot-shift testing. On average, KT-1000 arthrometer side-to-side difference was 0.52 mm closer to normal in patients treated with double-bundle reconstruction. This difference is demonstrated to be clinically insignificant. In addition, there was no statistical difference in the odds of having a normal or nearly normal pivot-shift result in patients treated with double-bundle versus single-bundle reconstruction.

Conclusion: Double-bundle reconstruction does not result in clinically significant differences in KT-1000 arthrometer or pivot-shift testing. The pivot-shift results have particular clinical relevance because the test is designed to evaluate knee rotational instability; the results do not support the theory that double-bundle reconstruction better controls knee rotation. Improved quality of future RCTs would allow meta-analysis of a greater number of outcome measures including measures of symptoms and disabilities most important to patients.

Key Words: anterior cruciate ligament (ACL) • single-bundle • double-bundle • outcome measures • meta-analysis






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