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.
STRONG RECOMMENDATION Rationale
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.
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.
- (1) Adachi N, Ochi M, Uchio Y, Iwasa J, Kuriwaka M, Ito Y. Reconstruction of the anterior cruciate ligament. Single- versus double-bundle multistranded hamstring tendons. J Bone Joint Surg Br 2004;86:515-520.
- (114) Suomalainen P, Moisala AS, Paakkala A, Kannus P, Jarvela T. Double-bundle versus single-bundle anterior cruciate ligament reconstruction: randomized clinical and magnetic resonance imaging study with 2-year follow-up. Am J Sports Med 2011;39:1615-1622.
- (123) Zhang Z, Gu B, Zhu W, Zhu L. Double-bundle versus single-bundle anterior cruciate ligament reconstructions: a prospective, randomized study with 2-year follow-up. Eur J Orthop Surg Traumatol 2013.
- (3) Aglietti P, Giron F, Buzzi R, Biddau F, Sasso F. Anterior cruciate ligament reconstruction: bone-patellar tendon-bone compared with double semitendinosus and gracilis tendon grafts. A prospective, randomized clinical trial. J Bone Joint Surg Am 2004;86-A:2143-2155.
- (5) Aglietti P, Giron F, Losco M, Cuomo P, Ciardullo A, Mondanelli N. Comparison between single-and double-bundle anterior cruciate ligament reconstruction: a prospective, randomized, single-blinded clinical trial. Am J Sports Med 2010;38:25-34.
- (51) Hussein M, van Eck CF, Cretnik A, Dinevski D, Fu FH. Individualized anterior cruciate ligament surgery: a prospective study comparing anatomic single- and double-bundle reconstruction. Am J Sports Med 2012;40:1781-1788.
- (53) Ibrahim SA, Hamido F, Al Misfer AK, Mahgoob A, Ghafar SA, Alhran H. Anterior cruciate ligament reconstruction using autologous hamstring double bundle graft compared with single bundle procedures. J Bone Joint Surg Br 2009;91:1310-1315.
- (56) Jarvela T, Moisala AS, Sihvonen R, Jarvela S, Kannus P, Jarvinen M. Double-bundle anterior cruciate ligament reconstruction using hamstring autografts and bioabsorbable interference screw fixation: prospective, randomized, clinical study with 2-year results. Am J Sports Med 2008;36:290-297.
- (77) Nunez M, Sastre S, Nunez E, Lozano L, Nicodemo C, Segur JM. Health-related quality of life and direct costs in patients with anterior cruciate ligament injury: single-bundle versus double-bundle reconstruction in a low-demand cohort--a randomized trial with 2 years of follow-up. Arthroscopy 2012;28:929-935.
- (79) Ochiai S, Hagino T, Senga S, Saito M, Haro H. Prospective evaluation of patients with anterior cruciate ligament reconstruction using a patient-based health-related survey: comparison of single-bundle and anatomical double-bundle techniques. Arch Orthop Trauma Surg 2012;132:393-398.
- (83) Park SJ, Jung YB, Jung HJ et al. Outcome of arthroscopic single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: a preliminary 2-year prospective study. Arthroscopy 2010;26:630-636.
- (99) Sastre S, Popescu D, Nunez M, Pomes J, Tomas X, Peidro L. Double-bundle versus single-bundle ACL reconstruction using the horizontal femoral position: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 2010;18:32-36.