SINGLE OR DOUBLE BUNDLE ACL RECONSTRUCTION

There are twenty-four high quality studies (Adachi 2004, Adrayanti 2017, Aga 2018, Aglietti 2010, Beyaz 2017, Ibrahim 2009, Jarvela 2017, Jarvela 2008, Kang 2015, Karikis 2016, Liu 2016, Mayr 2016, Mayr 2018, Mohtadi 2019, Mohtadi 2015, Mohtadi 2016, Núñez 2012, Sasaki 2016, Sun 2015, Suomalainen 2012, Suomalainen 2011, Yang 2017, Zhang 2014, Irrgang 2021) that compare single to double bundle ACL reconstruction. The majority of the studies demonstrate no statistically significant difference in any outcome parameters. Five meta-analyses demonstrated no statistically significant difference between single and double bundle reconstruction in post-operative pain, Lysholm, or IKDC subjective knee scores.

Benefits/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.

Outcome Importance

The many high quality studies demonstrate that either single- or double-bundle ACL reconstruction can result in excellent functional and clinical outcomes.

Cost Effectiveness/Resource Utilization

While equivalent in outcomes, double-bundle ACL reconstructions involve increased surgical time and increased costs.

Acceptability

Single and double bundle ACL reconstructions are both acceptable procedures for the reconstruction of ACL deficient knees, when indicated.

Feasibility

Both single- and double-bundle ACL reconstruction are feasible surgical treatment for ACL reconstruction.

Future Research

While no differences have been noted at 10-year follow up, future research is indicated to determine any differences between single and double bundle ACL reconstructions in the rate of degenerative changes at long-term (> 20 year) follow up.