Abstract
Purpose: Anterior cruciate ligament (ACL) reconstruction techniques have traditionally focused on reconstruction only of one bundle of the ACL providing good to excellent results in most cases. Biomechanical studies have shown increased anterior and rotational stability with double bundle(DB) compared to single bundle(SB) anterior cruciate ligament(ACL) reconstruction. A systematic review and meta-analysis was performed to compare double bundle and single bundle methods of anterior cruciate ligament reconstruction.
Methods and results: Medline (1966 onwards), EMBASE (1980 onwards) and the Cochrane database were searched retrieving 8465 possible articles, but only 5 studies fulfilled all the inclusion criteria. To be included, the study had to be prospective, randomised or quasi-randomised, comparing DB and SB grafts inserted using an arthroscopically assisted technique and have a minimum 18 month follow-up for all patients.
358 patients, 190 SB and 168 DB were considered for statistical analysis from these five papers. Outcome measures assessed included pivot shift testing, KT1000 arthrometer testing and IKDC knee scores. Using Review Manager 4.2 for statistical analysis; for dichotomous data, odds ratios and 95% confidence intervals were calculated and for continuous data, weighted mean difference and 95% confidence intervals were calculated.
Patients in the double bundle group were significantly less likely to have a positive pivot shift test (P< 0.0001). KT1000 arthrometer testing demonstrated greater antero-posterior stability with the DB group (P=0.002). There was no difference between the groups in terms of IKDC score.
Conclusion: The use of a double bundle technique improved both anteroposterior and rotational stability but not the clinical IKDC score suggesting that recovery of knee stability alone is not sufficient for achieving a better outcome.
Correspondence should be addressed to: BASK c/o BOA, at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England.
