Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective randomized study with 5-year results.
BACKGROUND
Surgical technique is essential in anterior cruciate ligament (ACL) reconstruction.


OBJECTIVE
This randomized 5-year study tested the hypothesis that double-bundle ACL reconstruction with hamstring autografts and aperture screw fixation has fewer graft ruptures and rates of osteoarthritis (OA) and better stability than single-bundle reconstruction.


METHODS
Randomized controlled trial; Level of evidence, 1.


METHODS
Ninety patients were randomized: double-bundle ACL reconstruction with bioabsorbable screw fixation (DB group; n = 30), single-bundle ACL reconstruction with bioabsorbable screw fixation (SBB group; n = 30), and single-bundle ACL reconstruction with metallic screw fixation (SBM group; n = 30). The following evaluation methods were used: clinical examination, KT-1000 arthrometer measurement, and International Knee Documentation Committee (IKDC) and Lysholm knee scores. Additionally, radiographic evaluation was made by a musculoskeletal radiologist who was unaware of the patients' clinical and surgical data. A single orthopaedic surgeon performed all the operations, and clinical follow-up assessments were made in a blinded manner by an independent examiner.


RESULTS
Preoperatively, there were no differences between the groups. Eleven patients (7 in the SBB group, 3 in the SBM group, and 1 in the DB group) had a graft failure during the follow-up and went on to ACL revision surgery (P < .043). Of the remaining 79 patients, a 5-year follow-up was performed for 65 patients (20 in the DB group, 21 in the SBB group, and 24 in the SBM group) who had their grafts intact. At 5 years, there was no statistically significant difference in the pivot-shift or KT-1000 arthrometer tests. In the DB group, 20% of the patients had OA in the medial femorotibial compartment and 10% in the lateral compartment, while the corresponding figures were 33% and 18% in the single-bundle groups, again an insignificant finding. Further, no significant group differences were found in the knee scores.


CONCLUSIONS
The double-bundle surgery resulted in significantly fewer graft failures and subsequent revision ACL surgery than the single-bundle surgeries during the 5-year follow-up. Knee stability and OA rates were similar at 5 years. In view of the size of the groups, some caution should be exercised when interpreting the lack of difference in the secondary outcomes.
Tampere University Hospital (TAYS), Teiskontie 35, Tampere, 33520, Finland. piia.suomalainen@uta.fi
Piia
P
Suomalainen
Timo
T
Järvelä
Antti
A
Paakkala
Pekka
P
Kannus
Markku
M
Järvinen
D020341:Absorbable Implants; D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects / Q000379:methods*; D001863:Bone Screws; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000209:etiology; D011446:Prospective Studies; D012421:Rupture / Q000209:etiology; D013710:Tendons / Q000637:transplantation*; D014182:Transplantation, Autologous; D017211:Treatment Failure; D055815:Young Adult