No consensus has been reached on the advantages of double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) over the single-bundle (SB) technique, particularly with respect to the prevention of osteoarthritis (OA) after ACLR.
To evaluate whether DB ACLR has any advantages in the prevention of OA or provides better stability and function after ACLR compared with the SB technique.
Randomized controlled trial; Level of evidence, 2.
A total of 130 patients with an ACL injury in one knee were prospectively randomized into a DB group (n = 65) or an SB group (n = 65). For the radiologic evaluation, we determined the degree of OA based on the Kellgren-Lawrence grade before the operation and at the time of the final follow-up and determined the number of patients with progression of OA more than one grade from pre- to postoperation. We evaluated the stability results using the Lachman and pivot-shift tests and stress radiography. We also compared the functional outcomes based on the Lysholm knee score, Tegner activity score, and International Knee Documentation Committee (IKDC) subjective scale.
Six patients (4 in the DB group and 2 in the SB group) suffered graft failure during the follow-up and had ACL revision surgery (P = .06). A total of 112 patients were observed for a minimum of 4 years (DB group, n = 52; SB group, n = 60). Five patients (9.6%) in the DB group and 6 patients (10%) in the SB group had more advanced OA at the final follow-up (P = .75). All patients recovered full range of motion within 6 months from surgery. Stability results of the Lachman test, pivot-shift test, and the radiographic stability test failed to reveal any significant intergroup differences (P = .37, .27, and .67, respectively). In the pivot-shift result, the DB group had 4 patients with grade 2 and the SB group had 3 patients with grade 2 (P = .27). Clinical outcomes, including Lysholm knee and Tegner activity scores, were similar in the 2 groups. Statistical significance was achieved only for the IKDC subjective scale (78.2 in DB group vs 73.1 in SB group; P = .03).
The DB technique, compared with SB, was not more effective in preventing OA and did not have a more favorable failure rate. Although the DB ACLR technique produced a better IKDC subjective scale result than did the SB ACLR technique, the 2 modalities were similar in terms of clinical outcomes and stability after a minimum 4 years of follow-up.