Journey around the Notch: A Systematic Review on the History of ACL Reconstruction in the United States

Anatomic Double-Bundle and Single-Bundle Reconstructions Yield Similar Outcomes Following Anterior Cruciate Ligament Rupture: A Systematic Review and Meta-analysis

PURPOSE

To evaluate outcomes of arthroscopic single-bundle (SB) versus anatomic double-bundle (ADB) anterior cruciate ligament reconstruction (ACLR) in adults through a synthesis of randomized controlled trials (RCTs). We hypothesized that SB and ADB methods would lead to similar outcomes after reconstruction of ACL rupture.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist guided our reporting. To identify RCTs that compared SB and ADB reconstructions, a thorough literature search was conducted of PubMed, Embase, Cochrane library, and Web of Science. The methodologic quality of each included study was independently assessed by 2 authors using the Cochrane Collaboration's risk of bias tool. The Anatomic ACL Reconstruction Scoring Checklist (AARSC) was used to screen the eligibility of each study's operative approaches. Twelve clinical outcomes were investigated through pooled analyses conducted using Review Manager 5.3.

RESULTS

This meta-analysis synthesized 13 RCTs comparing postoperative outcomes between ADB and SB reconstructions of ACLs. After a minimum follow-up of 12 months, ADB and SB technique resulted in similar subjective clinical outcomes, including the International Knee Documentation Committee subjective score, Lysholm score, Tegner activity score, and Knee injury and Osteoarthritis Outcome Score sports subscale. Similarly, no statistically significant outcomes were found for objective outcomes such as International Knee Documentation Committee objective grade, pivot-shift test, Lachman test, side-to-side difference, extension deficit, flexion deficit, and osteoarthritis change. However, patients who underwent SB reconstruction had significantly greater complication rates than those that underwent ADB reconstruction.

CONCLUSIONS

When an ACLR approach meets a minimal total AARSC score of 8, ADB and SB techniques may result in similar subjective and objective outcomes, but the ADB technique may lead to lower complication rates following surgery. We recommend that surgeons favor ADB ACLR, as guided by the AARSC.

LEVEL OF EVIDENCE

Level I, systematic review and meta-analysis of Level I randomized controlled trials.

Comparison of Rotatory and Sagittal Laxity After Single-Bundle Versus Double-Bundle ACL Reconstruction: Outcomes at 7-Year Follow-up

Background:

Biomechanical studies have shown excellent anteroposterior and rotatory laxity control after double-bundle (DB) anterior cruciate ligament (ACL) reconstruction, but no clinical studies have compared midterm (>5-year) residual laxity between the DB and single-bundle (SB) techniques.

Purpose:

To clinically compare sagittal and rotatory laxities and residual sagittal laxity on the KT-1000 arthrometer between patients treated with an SB ACL reconstruction and those treated with a DB ACL reconstruction at the 7-year follow-up.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A total of 110 patients were included between January 2006 and December 2007. The patients were randomly assigned into 2 groups: those treated with SB ACL reconstruction (n = 63) and those treated with the DB technique (n = 47). All patients were then reviewed at a minimum of 7 years of follow-up; patients with ACL rerupture (n = 3 in the SB group and n = 2 in the DB group) were excluded from the postoperative comparative analysis. Residual anterior laxity (Lachman test), rotatory laxity (pivot-shift test), and sagittal laxity (KT-1000 arthrometer side-to-side difference) were measured and compared between the 2 groups.

Results:

The mean age at surgery was 23.0 ± 5.1 years for the DB group and 28.1 ± 7.0 years for the SB group, and the mean follow-up was 7.4 ± 0.8 years. No statistically significant differences were found between the 2 groups in terms of age, sex, preoperative laxity on KT-1000, preoperative Tegner score, or concomitant meniscal lesions. Residual postoperative laxity via Lachman testing (P < .01), pivot-shift testing (P = .042), and the KT-1000 arthrometer (P < .01) was statistically significantly in favor of DB reconstruction.

Conclusion:

DB ACL reconstruction allowed better control of anterior stability during the evaluation via the Lachman test and via objective measurement on the KT-1000, as well as rotatory stability at a minimum of 7 years of follow-up.