A Prospective Randomized Study Comparing Arthroscopic Single-Bundle and Double-Bundle Posterior Cruciate Ligament Reconstructions Preserving Remnant Fibers

Abstract

Background: Several controversies exist regarding the superiority of double-bundle (DB) posterior cruciate ligament (PCL) reconstruction versus single-bundle (SB) reconstruction, although DB reconstruction has been shown to restore the intact knee kinematics more closely than SB reconstruction.

Hypothesis: Double-bundle PCL reconstruction will present better results than SB reconstruction in postoperative outcomes.

Study Design: Randomized controlled trial; Level of evidence, 2.

Methods: The authors prospectively analyzed 25 cases of SB reconstruction and 28 cases of DB reconstruction using Achilles tendon allograft with a minimum 2-year follow-up. They compared preoperative and postoperative range of motion, posterior stability by posterior stress radiography, Tegner activity score, Lysholm score, and International Knee Documentation Committee (IKDC) subjective knee evaluation form and knee examination form between the 2 groups.

Results: There was no difference in range of motion, Tegner activity score, Lysholm score, and IKDC subjective knee evaluation form between the 2 groups at last follow-up. The side-to-side difference in posterior translation significantly improved in both groups. There was no preoperative difference in posterior instability between the groups but a significant difference at last follow-up. On the IKDC knee examination form, the DB reconstruction group presented better results in grade distribution.

Conclusion: The DB reconstruction for PCL ruptures using the Achilles allograft showed better results in posterior stability and IKDC knee examination form than the SB reconstruction did. Although the difference of 1.4 mm in posterior stability was statistically significant, it is unclear that DB reconstruction is definitely superior to SB reconstruction clinically and functionally because there was no difference in the subjective scores.