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Single and double bundle posterior cruciate ligament reconstruction yield comparable clinical and functional outcomes: a systematic review and meta-analysis

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To perform a systematic review and compare the functional and objective outcomes after single-bundle (SB) vs. double-bundle (DB) posterior cruciate ligament reconstruction (PCLR). Where possible to pool outcomes and arrive at summary estimates of treatment effect for DB PCLR vs. SB PCLR via an embedded meta-analysis.

Methods

A comprehensive PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) literature search identified 13 eligible studies evaluating clinical outcomes of both techniques for PCLR. Clinical outcome measures included in the meta-analysis were functional outcomes (Lysholm Score, Tegner Activity Scale) and objective measurements of posterior laxity of the operated knee (arthrometer and stress radiographs).

Results

The meta-analysis included 603 patients. Three hundred and fifteen patients were treated with SB and two hundred and eighty-eight patients with DB PCLR. There were no significant differences between SB and DB PCLR in postoperative functional Lysholm Scores (CI [− 0.18, 0.17]), Tegner Activity Scales (CI [− 0.32, 0.12]) and IKDC objective grades (CI [− 0.13, 1.17]). Regarding posterior stability using KT-1000 and Kneelax III arthrometer measurements, there were no differences between the SB and DB group. However, double-bundle reconstruction provided better objective outcome of measurement of posterior laxity (CI [0.02, 0.46]) when measured with Telos stress radiography.

Conclusion

A systematic review was conducted to identify current best evidence pertaining to DB and SB PCLR. An embedded meta-analysis arrived at similar summary estimates of treatment effect for motion, stability and overall function for both techniques. There is no demonstrable clinically relevant difference between techniques based on the currently available evidence.

Level of evidence

III.

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Abbreviations

ALB:

Anterolateral bundle

BPTB:

Bone–patellar tendon–bone graft

DB:

Double-bundle

IKDC:

International Knee Documentation Committee

MINORS:

Methodological Index for non-randomized studies

NHLBI:

National Heart, Lung and Blood Institute

PCL:

Posterior cruciate ligament

PCLR:

Posterior cruciate ligament reconstruction

PMB:

Posteromedial bundle

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

RoB 2:

Cochrane risk-of-bias tool

SB:

Single-bundle

STG:

Semitendinosus and gracilis graft

TI:

Tibial inlay

TT:

Transtibial

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Funding

The authors have no conflicts of interest.

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Authors and Affiliations

  1. Department of Orthopaedics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany

    Nikolas L. Krott

  2. Women’s College Hospital, University of Toronto Orthopaedic Sports Medicine Program (UTOSM), Toronto, ON, Canada

    Lawrence Wengle & Daniel Whelan

  3. Department of Orthopaedics Trauma and Hand Surgery, Klinikum Darmstadt, Darmstadt, Germany

    Michael Wild

  4. Department of Orthopedics and Trauma Surgery, University Hospital Mannheim, Medical Faculty of the University Heidelberg, Mannheim, Germany

    Marcel Betsch

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  1. Nikolas L. Krott
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Correspondence to Nikolas L. Krott.

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Krott, N.L., Wengle, L., Whelan, D. et al. Single and double bundle posterior cruciate ligament reconstruction yield comparable clinical and functional outcomes: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 30, 2388–2399 (2022). https://doi.org/10.1007/s00167-022-06907-6

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