Anterior cruciate ligament (ACL) reconstruction has traditionally been performed using a single bundle (SB) technique, providing good to excellent results in most cases . There is some evidence from biomechanical studies that double bundle (DB) techniques may improve anteroposterior and rotational stability. A number of prospective randomised trials have been performed producing conflicting results. The aim of this study was to find out any differences in outcome between single bundle and double bundle ACL reconstruction.

A systematic review was performed to compare the evidence pertaining to the outcomes of double bundle versus single bundle ACL reconstruction methods. Medline (1966 onwards), EMBASE (1980 onwards) and the Cochrane database were searched, retrieving 9,568 possible articles. Only 6 studies fulfilled all the inclusion criteria. To be included, the study had to be prospective and randomised, comparing double bundle and single bundle grafts inserted using an arthroscopically assisted technique and have a minimum 12 month follow-up period for all patients. Analysis was performed using Review Manager (RevMan) [Computer program]. Version 5.0. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2008.

Five hundred and sixty patients (341 single bundle and 219 double bundle reconstructions) were considered for statistical analysis from these six papers. There was a significant difference between the groups with the double bundle reconstruction showing less of pivot shift positivity (P< 0.03). The DB group had significantly greater antero-posterior stability on KT arthrometer testing (P=0.002).

Double bundle ACL reconstruction improved both antero-posterior and rotational stability. There was also significant improvement in IKDC scores in patients with double bundle ACL reconstruction compared to single bundle reconstruction.