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Anatomical double-bundle anterior cruciate ligament reconstruction moderately improved tegner scores over the long-term: a systematic review and meta-analysis of randomized controlled trials

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To assess the effects of anatomical double-bundle (DB) versus single-bundle (SB) for anterior cruciate ligament (ACL) reconstruction in skeletally mature patients with ACL injuries.

Methods

MEDLINE, EMBASE, and CENTRAL were searched from inception to February 7, 2022 were screened for randomized controlled trials. The Anatomic Anterior Cruciate Ligament Reconstruction Checklist was used to categorize studies as anatomic. A random-effects meta-analysis was conducted, with pooled results being summarized using mean difference (MD). Risk of Bias (RoB) was assessed using the RoB 2.0 tool. Certainty of evidence was rated using GRADE.

Results

A search of 1371 unique articles yielded eight eligible trials, representing 735 patients (360 DB, 375 SB) with mean (SD) age of 28.5 (2.86) years and follow-up of 52.1 (36.2) months. Most trials had moderate to low RoB. Overall, DB was not significantly better than SB on Lysholm scores (MD = 0.52, 95% CI, − 1.80–2.85, p = 0.66; moderate certainty) or subjective International Knee Documentation Committee (IKDC) scores (MD = − 0.40, 95% CI, − 4.35–3.55, p = 0.84; moderate certainty). Tegner scores were significantly higher in SB than DB in the intermediate term (MD = − 0.72, 95% CI, − 1.10 to − 0.34, p = 0.0002; high certainty), while significantly higher in DB relative to SB in the long-term (MD = 0.52, 95% CI, 0.02–1.03, p = 0.04; high certainty).

Conclusion

DB ACL reconstruction significantly improves Tegner scores relative to SB ACL reconstruction over the long-term (t ≥ 5 years). Intermediate term Tegner scores favour SB reconstruction. In both durations, there was no clinically significant difference based on the pre-specified minimal clinically important difference of 1.0 point. There were also no significant differences in IKDC or Lysholm scores. Surgeons should consider anatomical DB ACL reconstruction as a result of long-term improvement in patient-reported outcomes.

Level of evidence

I.

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Acknowledgements

We are grateful for the help and support of Alexander Zakharia and Khaled Nawar during the article screening and data extraction stages. We are also thankful of our medical Liberian Denise Smith for her support with search strategy.

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Authors and Affiliations

  1. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada

    Yousif Eliya, Abdul-Rehman Qureshi & Jeffrey Kay

  2. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan

    Kanto Nagai

  3. Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan

    Yuichi Hoshino

  4. Department of Surgery, Division of Pediatric Orthopaedic Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada

    Darren de SA

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  1. Yousif Eliya
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Contributions

YE conceived the idea of the study, designed the study and critically revised the manuscript for important intellectual content. YE and KN conducted the literature search and determined studies for inclusion and exclusion. YE and KN extracted data from the studies included. YE and ABQ performed the meta-analysis. YE drafted the first manuscript. YE, ABQ contributed to data analysis, drafting and revising the article. All authors gave final the approval of the version to be published and agreed to be accountable for all aspects of the work.

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Correspondence to Darren de SA.

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Eliya, Y., Qureshi, AR., Kay, J. et al. Anatomical double-bundle anterior cruciate ligament reconstruction moderately improved tegner scores over the long-term: a systematic review and meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc 31, 436–448 (2023). https://doi.org/10.1007/s00167-022-07046-8

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