Winner of the 2007 Systematic Review Competition: Outcome of Single-Bundle versus Double-Bundle Reconstruction of the Anterior Cruciate Ligament

Abstract

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.

Keywords

anterior cruciate ligament (ACL)single-bundle double-bundle outcome measures meta-analysis

Get full access to this article

View all access options for this article.

References

Adachi

Ochi

Uchio

Iwasa

Kuriwaka

Ito

. Reconstruction of the anterior cruciate ligament: Single- versus double-bundle multistranded hamstring tendons. J Bone Joint Surg Br. 2004; 86:515–520.

Aglietti

Giron

Cuomo

Losco

Mondanelli

. Single- and double-incision double-bundle ACL reconstruction. Clin Orthop Relat Res. 2007;454:108–113.

Asagumo

Kimura

Kobayashi

Taki

Takagishi

. Anatomic reconstruction of the anterior cruciate ligament using double-bundle hamstring tendons: Surgical techniques, clinical outcomes, and complications. Arthroscopy. 2007;23:602–609.

Beynnon

Johnson

Abate

Fleming

Nichols

. Treatment of anterior cruciate ligament injuries: Part 1. Am J Sports Med. 2005;33:1579–1602.

Beynnon

Johnson

Abate

Fleming

Nichols

. Treatment of anterior cruciate ligament injuries: Part 2. Am J Sports Med. 2005;33:1751–1767.

Carr

. Evidence-based orthopaedic surgery: What type of research will best improve clinical practice? J Bone Joint Surg Br. 2005; 87:1593–1594.

Chan

Bhandari

. The quality of reporting of orthopaedic randomized trials with use of a checklist for nonpharmacological therapies. J Bone Joint Surg Am. 2007;89:1970–1978.

Cowan

Lozano-Calderón

Ring

. Quality of prospective controlled randomized trials: Analysis of trials of treatment for lateral epicondylitis as an example. J Bone Joint Surg Am. 2007;89:1693–1699.

Crawford

Nyland

Landes

. Anatomic double bundle ACL reconstruction: A literature review. Knee Surg Sports Traumatol Arthrosc. 2007;15:946–964.

10.

Daniel

Stone

Sachs

Malcom

. Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption. Am J Sports Med. 1985;13:401–407.

11.

IKDC Committee: AOSSM: Anderson A, Bergfeld J, Boland A, et al. ESSKA: Staubli H, Hefti F, Hoher J, Jacob R, Mueller W, Neyret P. APOSSM: Chan K, Kurosaka M. 2000 IKDC Knee Forms. Available at http://www.sportsmed.org/tabs/research/ikdc.aspx. Accessed April 8, 2008.

12.

Irrgang

Anderson

Boland

. Development and validation of the International Knee Documentation Committee subjective knee form. Am J Sports Med. 2001;29:600–613.

13.

Jarvela

. Double-bundle versus single-bundle anterior cruciate ligament reconstruction: A prospective, randomized clinical study. Knee Surg Sports Traumatol Arthrosc. 2007;15:500–507.

14.

Jarvela

Moisala

Sihvonen

Jarvela

Kannus

Jarvinen

. Double-bundle anterior cruciate ligament reconstruction using hamstring autografts and bioabsorbable interference screw fixation: Prospective, randomized clinical study with two-year results. Am J Sports Med. 2008;36:290–297. Epub 2007 Oct 16.

15.

Moher

Schulz

Altman

. CONSORT. The CONSORT statement: Revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Med Res Methodol. 2001;1:2.

16.

Mohtadi

. Development and validation of the quality of life outcome measure (questionnaire) for chronic anterior cruciate ligament deficiency. Am J Sports Med. 1998;26:350–359.

17.

Muneta

Koga

Mochizuki

. A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques. Arthroscopy. 2007;23:618–628.

18.

Muneta

Koga

Morito

Yagishita

Sekiya

. A retrospective study of the midterm outcome of two-bundle anterior cruciate ligament reconstruction using quadrupled semitendinosus tendon in comparison with one-bundle reconstruction. Arthroscopy. 2006; 22:252–258.

19.

Musahl

Bell

Tsai

. Development of a simple device for measurement of rotational knee laxity. Knee Surg Sports Traumatol Arthrosc. 2007;15:1009–1012.

20.

Norwood

Cross

. Anterior cruciate ligament: Functional anatomy of its bundles in rotatory instabilities. Am J Sports Med. 1979;7:23–26.

21.

Norwood

Cross

. The intercondylar shelf and the anterior cruciate ligament. Am J Sports Med. 1977;5:171–176.

22.

Sutton

Abrams

Jones

Sheldon

Song

. Methods for Meta-Analysis in Medical Research. West Sussex, England: John Wiley & Sons Ltd; 2000.

23.

Tanner

Dainty

Marx

Kirkley

. Knee-specific quality-of-life instruments: Which ones measure symptoms and disabilities most important to patients? Am J Sports Med. 2007;35:1450–1458.

24.

Woo

Kanamori

Zeminski

Yagi

Papageorgiou

. The effectiveness of reconstruction of the anterior cruciate ligament with hamstrings and patellar tendon: A cadaveric study comparing anterior tibial and rotational loads. J Bone Joint Surg Am. 2002;84:907–914.

25.

Yagi

Kuroda

Nagamune

Yoshiya

Kurosaka

. Double-bundle ACL reconstruction can improve rotational stability. Clin Orthop Relat Res. 2007;454:100–107.

26.

Yagi

Wong

Kanamori

Debski

Woo

. Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med. 2002;30:660–666.

27.

Yasuda

Kondo

Ichiyama

Tanabe

Tohyama

. Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: Comparisons among 3 different procedures. Arthroscopy. 2006;22:240–251.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.03 MB