Single or Double Bundle Reconstruction
Strong evidence supports that in patients undergoing intra-articular ACL reconstruction the practitioner should use either single bundle or double bundle technique, because the measured outcomes are similar.

There are four high and eight moderate strength studies that compare single to double bundle ACL reconstruction.1, 3, 5, 51, 53, 56, 77, 79, 83, 99, 114, 123  The majority of the studies demonstrate no statistically significant difference in any outcome parameters. Meta-analysis demonstrated no statistically significant difference between single and double bundle reconstruction in post-operative pain, Lysholm or IKDC subjective knee scores.

Potential Harms of Implementation
As with all surgery procedures, there are surgical risks and complications including but not limited to, graft failure, arthrofibrosis, infection, neurovascular injury, and anesthetic complications.

Future Research
Long-term prospective, randomized studies comparing single and double bundle reconstruction should be performed to document clinical outcomes, degree of tunnel enlargement, traumatic arthritis, and incidence and results of subsequent revision surgeries. Double bundle surgery may include additional expense, and may increase the complexity of revision ACL surgery; future studies may analyze this surgical approach.


The Future of OrthoGuidelines


The OrthoGuidelines Process