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Double-bundle anterior cruciate ligament reconstruction technique has advantages in chondroprotection and knee laxity control compared with single-bundle technique

A long-term follow-up with a minimum of 12 years

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To compare the long-term clinical outcomes of single-bundle anterior cruciate ligament reconstruction (SBR) and double-bundle anterior cruciate ligament reconstruction (DBR) in patients with isolated anterior cruciate ligament (ACL) rupture, presenting no meniscus injury and no obvious preoperative cartilage degeneration.

Methods

One hundred and three patients (38.6 ± 9.5 years) with a median follow-up of 151.6 months (range, 144–189 months) completed the retrospective study (SBR group: n = 51; DBR group: n = 52). Clinical outcomes were evaluated with physical examinations, KT-2000 anterior and posterior stability measurement with the knee in 30º of flexion, International Knee Documentation Committee (IKDC) subjective score, Tegner score, Lysholm score; magnetic resonance imaging (MRI) (3.0 T) was performed, and International Cartilage Repair Society (ICRS) cartilage degeneration grades were determined. Multivariate analysis was performed to identify factors associated with cartilage degeneration.

Results

There were significant differences in the pre- and postoperative IKDC, Lysholm and Tegner scores between the SBR and DBR groups. The SBR group had over double the rate of positive pressure/rub patellar test results (SBR vs DBR, 43.1% vs. 19.2%, p < 0.011). The KT-2000, pivot-shift and Lachman test results were stratified and analyzed, and significant differences between the SBR and DBR groups were found (p < 0.05, respectively). The distribution of ICRS grades differed significantly between the groups at the last follow-up (p = 0.013). A multivariate analysis found that age and operation procedures were significant predictors of 0 and non-0 ICRS grades (odds ratio, 6.077 [95% CI 2.117–17.447] and 0.210 [95% CI 0.068–0.654], respectively) (p < 0.05).

Conclusion

Both SBR and DBR achieved overall good long-term results. DBR had advantages in objective outcome measures and was superior in preventing the occurrence of cartilage degeneration. Age was identified as a preoperative risk factor for significant postoperative cartilage degeneration.

Level of evidence

III.

ClinicalTrials.gov: NCT03984474

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References

  1. Adravanti P, Dini F, de Girolamo L, Cattani M, Rosa MA (2017) Single-bundle versus double-bundle anterior cruciate ligament reconstruction: a prospective randomized controlled trial with 6-year follow-up. J Knee Surg 30:898–904

    Article  Google Scholar 

  2. Aga C, Risberg MA, Fagerland MW, Johansen S, Troan I, Heir S et al (2018) No difference in the KOOS quality of life subscore between anatomic double-bundle and anatomic single-bundle anterior cruciate ligament reconstruction of the knee: a prospective randomized controlled trial with 2 years’ follow-up. Am J Sports Med 46:2341–2354

    Article  Google Scholar 

  3. Aglietti P, Giron F, Losco M, Cuomo P, Ciardullo A, Mondanelli N (2010) Comparison between single-and double-bundle anterior cruciate ligament reconstruction: a prospective, randomized, single-blinded clinical trial. Am J Sports Med 38:25–34

    Article  Google Scholar 

  4. Amis AA (2012) The functions of the fibre bundles of the anterior cruciate ligament in anterior drawer, rotational laxity and the pivot shift. Knee Surg Sports Traumatol Arthrosc 20:613–620

    Article  Google Scholar 

  5. Amis AA, Beynnon B, Blankevoort L, Chambat P, Christel P, Durselen L et al (1994) Proceedings of the ESSKA Scientific Workshop on Reconstruction of the Anterior and Posterior Cruciate Ligaments. Knee Surg Sports Traumatol Arthrosc 2:124–132

    Article  CAS  Google Scholar 

  6. Arciero RA (2016) Double-bundle and single-bundle acl reconstruction techniques did not differ in terms of clinical outcomes at 2 or 5 years. J Bone Jt Surg Am 98:1933–1934

    Article  Google Scholar 

  7. Belk JW, Kraeutler MJ, Houck DA, McCarty EC (2019) Knee osteoarthritis after single-bundle versus double-bundle anterior cruciate ligament reconstruction: a systematic review of randomized controlled trials. Arthroscopy 35:996–1003

    Article  Google Scholar 

  8. Bodkin SG, Werner BC, Slater LV, Hart JM (2019) Post-traumatic osteoarthritis diagnosed within 5 years following ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-019-05461-y

    Article  PubMed  Google Scholar 

  9. Cantin O, Lustig S, Rongieras F, Saragaglia D, Lefevre N, Graveleau N et al (2016) Outcome of cartilage at 12years of follow-up after anterior cruciate ligament reconstruction. Orthop Traumatol Surg Res 102:857–861

    Article  CAS  Google Scholar 

  10. Chen H, Chen B, Tie K, Fu Z, Chen L (2018) Single-bundle versus double-bundle autologous anterior cruciate ligament reconstruction: a meta-analysis of randomized controlled trials at 5-year minimum follow-up. J Orthop Surg Res 13:50

    Article  Google Scholar 

  11. Chen K, Zhu W, Zheng Y, Zhang F, Ouyang K, Peng L et al (2020) A retrospective study to compare the clinical effects of individualized anatomic single- and double-bundle anterior cruciate ligament reconstruction surgery. Sci Rep 10:14712

    Article  CAS  Google Scholar 

  12. Chia ZY, Chee JN, Bin-Abd-Razak HR, Lie DT, Chang PC (2018) A comparative study of anterior cruciate ligament reconstruction with double, single, or selective bundle techniques. J Orthop Surg (Hong Kong) 26:2309499018773124

    Article  Google Scholar 

  13. Costa-Paz M, Garcia-Mansilla I, Marciano S, Ayerza MA, Muscolo DL (2019) Knee-related quality of life, functional results and osteoarthritis at a minimum of 20years’ follow-up after anterior cruciate ligament reconstruction. Knee 26:666–672

    Article  Google Scholar 

  14. Culvenor AG, Cook JL, Collins NJ, Crossley KM (2013) Is patellofemoral joint osteoarthritis an under-recognised outcome of anterior cruciate ligament reconstruction? A narrative literature review. Br J Sports Med 47:66–70

    Article  Google Scholar 

  15. Dong Z, Niu Y, Qi J, Song Y, Wang F (2019) Long term results after double and single bundle ACL reconstruction: Is there any difference? A meta-Analysis of randomized controlled trials. Acta Orthop Traumatol Turc. https://doi.org/10.1016/j.aott.2018.12.004

    Article  PubMed  PubMed Central  Google Scholar 

  16. El-Sherief FAH, Aldahshan WA, Wahd YE, Abdelaziz AM, Soliman HAG, Hassan TG et al (2018) Double-bundle anterior cruciate ligament reconstruction is better than single-bundle reconstruction in terms of objective assessment but not in terms of subjective score. Knee Surg Sports Traumatol Arthrosc 26:2395–2400

    Article  Google Scholar 

  17. Gong X, Jiang D, Wang YJ, Wang J, Ao YF, Yu JK (2013) Second-look arthroscopic evaluation of chondral lesions after isolated anterior cruciate ligament reconstruction: single- versus double-bundle reconstruction. Am J Sports Med 41:2362–2367

    Article  Google Scholar 

  18. Hussein M, van Eck CF, Cretnik A, Dinevski D, Fu FH (2012) Prospective randomized clinical evaluation of conventional single-bundle, anatomic single-bundle, and anatomic double-bundle anterior cruciate ligament reconstruction: 281 cases with 3- to 5-year follow-up. Am J Sports Med 40:512–520

    Article  Google Scholar 

  19. Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P et al (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29:600–613

    Article  CAS  Google Scholar 

  20. Jarvela S, Kiekara T, Suomalainen P, Jarvela T (2017) Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective randomized study with 10-year results. Am J Sports Med 45:2578–2585

    Article  Google Scholar 

  21. Jiang D, Ao YF, Gong X, Wang YJ, Luo H, Chen LX et al (2012) Double-bundle anterior cruciate ligament reconstruction using bone-patellar tendon-bone allograft: technique and 2- to 5-year follow-up. Am J Sports Med 40:1084–1092

    Article  Google Scholar 

  22. Joseph C, Pathak SS, Aravinda M, Rajan D (2008) Is ACL reconstruction only for athletes? A study of the incidence of meniscal and cartilage injuries in an ACL-deficient athlete and non-athlete population: an Indian experience. Int Orthop 32:57–61

    Article  Google Scholar 

  23. Lecoq FA, Parienti JJ, Murison J, Ruiz N, Bouacida K, Besse J et al (2018) Graft choice and the incidence of osteoarthritis after anterior cruciate ligament reconstruction: a causal analysis from a cohort of 541 patients. Am J Sports Med 46:2842–2850

    Article  Google Scholar 

  24. Li RT, Lorenz S, Xu Y, Harner CD, Fu FH, Irrgang JJ (2011) Predictors of radiographic knee osteoarthritis after anterior cruciate ligament reconstruction. Am J Sports Med 39:2595–2603

    Article  Google Scholar 

  25. Maeyama A, Hoshino Y, Kato Y, Debandi A, Lertwanich P, Wang JH et al (2018) Anatomic double bundle ACL reconstruction outperforms any types of single bundle ACL reconstructions in controlling dynamic rotational laxity. Knee Surg Sports Traumatol Arthrosc 26:1414–1419

    Article  CAS  Google Scholar 

  26. Mayr HO, Bruder S, Hube R, Bernstein A, Suedkamp NP, Stoehr A (2018) Single-bundle versus double-bundle anterior cruciate ligament reconstruction-5-year results. Arthroscopy 34:2647–2653

    Article  Google Scholar 

  27. Oiestad BE, Holm I, Risberg MA (2018) Return to pivoting sport after ACL reconstruction: association with osteoarthritis and knee function at the 15-year follow-up. Br J Sports Med 52:1199–1204

    Article  Google Scholar 

  28. Oishi K, Sasaki E, Naraoka T, Kimura Y, Tsuda E, Shimoda H et al (2018) Anatomical relationship between insertion sites, tunnel placement, and lateral meniscus anterior horn injury during single and double bundle anterior cruciate ligament reconstructions: A comparative macroscopic and histopathological evaluation in cadavers. J Orthop Sci. https://doi.org/10.1016/j.jos.2018.10.021

    Article  PubMed  Google Scholar 

  29. Schreiber VM, Jordan SS, Bonci GA, Irrgang JJ, Fu FH (2017) The evolution of primary double-bundle ACL reconstruction and recovery of early post-operative range of motion. Knee Surg Sports Traumatol Arthrosc 25:1475–1481

    Article  Google Scholar 

  30. Svantesson E, Sundemo D, Hamrin Senorski E, Alentorn-Geli E, Musahl V, Fu FH et al (2017) Double-bundle anterior cruciate ligament reconstruction is superior to single-bundle reconstruction in terms of revision frequency: a study of 22,460 patients from the Swedish National Knee Ligament Register. Knee Surg Sports Traumatol Arthrosc 25:3884–3891

    Article  Google Scholar 

  31. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    Google Scholar 

  32. Wang HJ, Ao YF, Chen LX, Gong X, Wang YJ, Ma Y et al (2011) Second-look arthroscopic evaluation of the articular cartilage after primary single-bundle and double-bundle anterior cruciate ligament reconstructions. Chin Med J (Engl) 124:3551–3555

    Google Scholar 

  33. Wang HJ, Ao YF, Jiang D, Gong X, Wang YJ, Wang J et al (2015) Relationship between quadriceps strength and patellofemoral joint chondral lesions after anterior cruciate ligament reconstruction. Am J Sports Med 43:2286–2292

    Article  Google Scholar 

  34. Wang X, Bennell KL, Wang Y, Wrigley TV, Van Ginckel A, Fortin K et al (2019) Tibiofemoral joint structural change from 2.5 to 4.5 years following ACL reconstruction with and without combined meniscal pathology. BMC Musculoskelet Disord 20:312

    Article  Google Scholar 

  35. Zantop T, Herbort M, Raschke MJ, Fu FH, Petersen W (2007) The role of the anteromedial and posterolateral bundles of the anterior cruciate ligament in anterior tibial translation and internal rotation. Am J Sports Med 35:223–227

    Article  Google Scholar 

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Funding

This research was funded by Peking University Health Science Center, Grant numbers [A63498-24 and BMU2018 MX023], Peking University Third Hospital, Grant numbers [BYSY2018004 and BMU2019GJJXK012], Capital's Funds for Health Improvement and Research, Grant number [CFH2018-2-4098].

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Author notes

  1. Zimu Mao and Jian Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Sports Medicine, Peking University Third Hospital, Beijing, China

    Zimu Mao, Jian Wang, Yongjian Wang, Dong Jiang, Xinjie Wang, Haijun Wang, Lin Lin, Yang Liu & Jiakuo Yu

  2. Institute of Sports Medicine of Peking University, Beijing, China

    Zimu Mao, Jian Wang, Yongjian Wang, Dong Jiang, Xinjie Wang, Haijun Wang, Lin Lin, Yang Liu & Jiakuo Yu

  3. Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing, China

    Lin Zeng

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  1. Zimu Mao
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Contributions

ZM: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work. JW: Acquisition, analysis, or interpretation of data for the work, drafting the work or revising it critically for important intellectual content. YW: Drafting the work or revising it critically for important intellectual content. DJ: drafting the work or revising it critically for important intellectual content. XW: drafting the work or revising it critically for important intellectual content. HW: MD, drafting the work or revising it critically for important intellectual content. LL: Drafting the work or revising it critically for important intellectual content. YL: Drafting the work or revising it critically for important intellectual content. LZ: Drafting the work or revising it critically for important intellectual content. JY: Final approval of the version to be published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding authors

Correspondence to Lin Zeng or Jiakuo Yu.

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Ethical approval as shown in manuscript, was approved by Peking University Third Hospital Medical Science Research Ethics Committee (No. IRB00006761-2011097).

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Mao, Z., Wang, J., Wang, Y. et al. Double-bundle anterior cruciate ligament reconstruction technique has advantages in chondroprotection and knee laxity control compared with single-bundle technique. Knee Surg Sports Traumatol Arthrosc 29, 3105–3114 (2021). https://doi.org/10.1007/s00167-020-06350-5

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