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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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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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.
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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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DOI: https://doi.org/10.1007/s00167-020-06350-5