Skip to main content

Advertisement

Log in

Double-bundle versus single-bundle anterior cruciate ligament reconstructions: a prospective, randomized study with 2-year follow-up

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

This prospective, randomized study was conducted to compare the short-term results of arthroscopic double-bundle with single-bundle anterior cruciate ligament (ACL) reconstruction. One hundred and eight patients with a symptomatic ACL rupture were randomized to either double-bundle (Group DB) or single-bundle (Group SB) ACL reconstruction. Follow-up was conducted at 6, 12, 18 and 24 months postoperatively. At the 24-month follow-up, 94 of the 108 patients (87 %) were available for evaluation. The rotational stability, as evaluated by pivot shift test, was significantly superior in the Group DB to that in the Group SB. No significant difference with regard to ACL revisions, total flexion work, mean peak flexion torque and extension work between the groups was detected. There was no significant difference between the groups in terms of the Tegner activity score, the knee injury and osteoarthritis outcome score, the Lysholm functional score, anterior knee pain or mobility, subjective knee function. In addition, no significant difference in laxity on the Lachman test or the KT-1000 maximum manual force test was investigated. All the results were significantly more satisfactory at each follow-up period than preoperatively, in both groups. Both SB- and DB-ACL reconstruction resulted in satisfactory subjective outcome and objective stability. Both these techniques can therefore be considered as suitable alternatives for ACL reconstruction. Moreover, as it seems to be according to the pivot shift test, the risk for the development of degenerative changes of the knee joint in a long run could be smaller in the Group DB.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Schindler OS (2012) Surgery for anterior cruciate ligament deficiency: a historical perspective. Knee Surg Sports Traumatol Arthrosc 20:5–47

    Article  PubMed  Google Scholar 

  2. Monaco E, Maestri B, Labianca L (2010) Clinical and radiological outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction. J Orthop Sci 15:198–203

    Article  PubMed  Google Scholar 

  3. Almqvist KF, Willaert P, Brabandere SD, Criel K, Verdonk R (2009) A long-term study of anterior cruciate ligament allograft reconstruction. Knee Surg Sports Traumatol Arthrosc 17:818–822

    Article  CAS  PubMed  Google Scholar 

  4. van Eck CF, Romanowski JR, Fu FH (2009) Anatomic single-bundle anterior cruciate ligament reconstruction. Arthroscopy 25(9):943–946

    Article  PubMed  Google Scholar 

  5. Vanlauwe J, Almqvist KF, Bellemans J (2007) Repair of symptomatic cartilage lesions of the knee. The place of autologous chondrocyte implantation. Acta Orthop Belg 73:145–158

    PubMed  Google Scholar 

  6. Cha J, Choi SH, Kwon JW, Lee SH, Ahn JH (2012) Analysis of cyclops lesions after different anterior cruciate ligament reconstructions: a comparison of the single-bundle and remnant bundle preservation techniques. Skeletal Radiol 41:997–1002

    Article  PubMed  Google Scholar 

  7. Petrigliano FA, Musahl V, Suero EM, Citak M, Pearle AD (2011) Effect of meniscal loss on knee stability after single-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 19(1):86–93

    Article  Google Scholar 

  8. Gerhard P, Bolt R, Duck K, Mayer R, Friederich NF, Hirschmann MT (2013) Long-term results of arthroscopically assisted anatomical single-bundle anterior cruciate ligament reconstruction using patellar tendon autograft: are there any predictors for the development of osteoarthritis? Knee Surg Sports Traumatol Arthrosc 21(4):957–964

    Article  PubMed  Google Scholar 

  9. Siebold R (2008) One-bundle anterior cruciate ligament augmentation using the anatomic reconstruction concept. Oper Tech Sport Med 16(3):148–156

    Article  Google Scholar 

  10. Steenbrugge F, Verdonk R, Vorlat P (2001) Repair of chronic ruptures of the anterior cruciate ligament using allograft reconstruction and a ligament augmentation device. Acta Orthop Belg 67:252–258

    CAS  PubMed  Google Scholar 

  11. Girgis FG, Marshall JL, Monajem A (1975) The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop Relat Res 3:216–231

    Article  Google Scholar 

  12. Amis AA, Dawkins GP (1991) Functional anatomy of the anterior cruciate ligament. Fibre bundle actions related to ligament replacements and injuries. J Bone Joint Surg Br 73:260–267

    CAS  PubMed  Google Scholar 

  13. Mochizuki T, Muneta T, Nagase T, Shirasawa S, Akita KI, Sekiya I (2006) Cadaveric knee observation study for describing anatomic femoral tunnel placement for two-bundle anterior cruciate ligament reconstruction. Arthroscopy 22:356–361

    Article  PubMed  Google Scholar 

  14. Järvelä T, Järvelä S (2013) Double-bundle versus single-bundle anterior cruciate ligament reconstruction. Clin Sport Med 32(1):81–91

    Article  Google Scholar 

  15. Kim SJ, Jo SB, Kumar P, Oh KS (2009) Comparison of single- and double-bundle anterior cruciate ligament reconstruction using quadriceps tendon-bone. Arthroscopy 25(1):70–77

    Article  PubMed  Google Scholar 

  16. Li YL, Ning JZ, Wu Q, Wu QL, Li Y, Hao Y, Feng SQ (2013) Single-bundle or double-bundle for anterior cruciate ligament reconstruction: a meta-analysis. The Knee (in press)

  17. Misonoo G, Kanamori A, Ida H, Miyakawa S, Ochiai N (2012) Evaluation of tibial rotational stability of single-bundle vs. anatomical double-bundle anterior cruciate ligament reconstruction during a high-demand activity—a quasi-randomized trial. Knee 19(2):87–93

    Article  PubMed  Google Scholar 

  18. Adachi N, Ochi M, Uchio Y, Iwasa J, Kuriwaka M, Ito Y (2004) Reconstruction of the anterior cruciate ligament. Single- versus double-bundle multistranded hamstring tendons. J Bone Joint Surg Br 86:515–520

    CAS  PubMed  Google Scholar 

  19. Clancy WG Jr (2009) Single-tunnel, double-bundle anterior cruciate ligament reconstruction: clinical evaluation, treatment options, and surgical technique. Clin Sport Med 17(1):16–23

    Google Scholar 

  20. Tsarouhas A, Iosifidis M, Spyropoulos G, Kotzamitelos D, Tsatalas T, Giakas G (2011) Tibial rotation under combined in vivo loading after single- and double-bundle anterior cruciate ligament reconstruction. Arthroscopy 27(12):1654–1662

    Article  PubMed  Google Scholar 

  21. Li X, Xu CP, Song JQ, Jiang N, Yu B (2013) Single-bundle versus double-bundle anterior cruciate ligament reconstruction: an up-to-date meta-analysis. Int Orthop 37(2):213–226

    Article  PubMed Central  PubMed  Google Scholar 

  22. Sastre S, Popescu D, Nunez M, Pomes J, Tomas X, Peidro L (2010) Double-bundle versus single-bundle ACL reconstruction using the horizontal femoral position: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 18:32–36

    Article  PubMed  Google Scholar 

  23. Streich NA, Friedrich K, Gotterbarm T, Schmitt H (2008) Reconstruction of the ACL with a semitendinosus tendon graft: a prospective randomized single blinded comparison of double-bundle versus single-bundle technique in male athletes. Knee Surg Sports Traumatol Arthrosc 16:232–238

    Article  PubMed  Google Scholar 

  24. Järvelä T (2007) Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective, randomize clinical study. Knee Surg Sports Traumatol Arthrosc 15:500–507

    Article  PubMed  Google Scholar 

  25. Tsuda E, Ishibashi Y, Fukuda A, Tsukada H, Toh S (2009) Comparable results between lateralized single- and double-bundle ACL reconstructions. Clin Orthop Relat Res 467:1042–1055

    Article  PubMed Central  PubMed  Google Scholar 

  26. Ho JY, Gardiner A, Shah V, Steiner ME (2009) Equal kinematics between central anatomic single-bundle and double-bundle anterior cruciate ligament reconstructions. Arthroscopy 25(5):464–472

    Article  PubMed  Google Scholar 

  27. Aglietti P, Giron F, Cuomo P, Losco M, Mondanelli N (2007) Single-and double-incision double-bundle ACL reconstruction. Clin Orthop Relat Res 454:108–113

    Article  PubMed  Google Scholar 

  28. 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  PubMed  Google Scholar 

  29. Sugimoto D, Myer GD, Bush HM, Klugman MF, Medina McKeon JM, Hewett TE (2012) Compliance with neuromuscular training and anterior cruciate ligament injury risk reduction in female athletes: a meta-analysis. J Athl Train 47(6):714–723

    Article  PubMed Central  PubMed  Google Scholar 

  30. Claes S, Hermie L, Verdonk R, Bellemans J, Verdonk P (2012) Is osteoarthritis an inevitable consequence of anterior cruciate ligament reconstruction? A meta-analysis. Knee Surg Sports Traumatol Arthrosc (in press)

  31. Sun L, Zhao J, Shen J, Du B, Yuan B (2012) Anatomic single-bundle anterior cruciate ligament reconstruction in Asian population. ANZ J Surg 83(4):262–267

    Article  PubMed  Google Scholar 

  32. Lee S, Kim H, Jang J, Seong SC, Lee MC (2012) Comparison of anterior and rotatory laxity using navigation between single- and double-bundle ACL reconstruction: prospective randomized trial. Knee Surg Sports Traumatol Arthrosc 20:752–761

    Article  PubMed  Google Scholar 

  33. Marx RG (2012) Single- versus double-bundle anterior cruciate ligament reconstruction. Clin Orthop Relat Res 471(2):363–367

    Article  PubMed Central  Google Scholar 

  34. Hussein M, van Eck CF, Cretnik A, Dinevski D, Fu FH (2012) Individualized anterior cruciate ligament surgery: a prospective study comparing anatomic single- and double-bundle reconstruction. Am J Sports Med 40(8):1781–1788

    Article  PubMed  Google Scholar 

  35. Li YL, Ning GZ, Wu Q, Wu QL, Li Y, Hao Y, Feng SQ (2013) Single-bundle or double-bundle for anterior cruciate ligament reconstruction: a meta-analysis. Knee (in press)

  36. van Eck CF, Kopf S, Irrgang JJ, Blankevoort L, Bhandari M, Fu FH, Poolman RW (2012) Single-bundle versus double-bundle reconstruction for anterior cruciate ligament rupture: a meta-analysis–does anatomy matter? Arthroscopy 28(3):405–424

    Article  PubMed  Google Scholar 

  37. Heijne A, Werner S (2010) A 2-year follow-up of rehabilitation after ACL reconstruction using patellar tendon or hamstring tendon grafts: a prospective randomised outcome study. Knee Surg Sports Traumatol Arthrosc 18:805–813

    Article  PubMed  Google Scholar 

  38. Hiemstra LA, Webber S, MacDonald PB (2007) Contralateral limb strength deficits after anterior cruciate ligament reconstruction using a hamstring tendon graft. Clin Biomech 22(5):543–550

    Article  Google Scholar 

  39. Gabriel MT, Wong EK, Woo SL, Yagi M, Debski RE (2004) Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads. J Orthop Res 22(1):85–89

    Article  PubMed  Google Scholar 

  40. Adachi N, Ochi M, Uchio Y, Iwasa J, Kuriwaka M, Ito Y (2004) Reconstruction of the anterior cruciate ligament. Single- versus double-bundle multistranded hamstring tendons. J Bone Joint Surg Br 86(4):515–520

    CAS  PubMed  Google Scholar 

  41. Fetzer GB, Spindler KP, Amendola A (2009) Potential market for new meniscus repair strategies: evaluation of the MOON cohort. J Knee Surg 22:180–186

    Article  PubMed Central  PubMed  Google Scholar 

  42. Levy AS, Meier SW (2003) Approach to cartilage injury in the anterior cruciate ligament-deficient knee. Orthop Clin North Am 34:149–167

    Article  PubMed  Google Scholar 

  43. Musahl V, Jordan SS, Colvin AC, Tranovich MJ, Irrgang JJ, Harner CD (2010) Practice patterns for combined anterior cruciate ligament and meniscal surgery in the United States. Am J Sports Med 38:918–923

    Article  PubMed  Google Scholar 

  44. Nakata K, Shino K, Horibe S (2008) Arthroscopic anterior cruciate ligament reconstruction using fresh-frozen bone plug-free allogeneic tendons: 10-year follow-up. Arthroscopy 24:285–291

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

No funds were received in support of this study.

Ethical standard

The study has been approved by the Regional Ethics Committee and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to Zhenxiang Zhang or Wei Zhu.

Additional information

Zhenxiang Zhang and Beibei Gu are co-first authors.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhang, Z., Gu, B., Zhu, W. et al. Double-bundle versus single-bundle anterior cruciate ligament reconstructions: a prospective, randomized study with 2-year follow-up. Eur J Orthop Surg Traumatol 24, 559–565 (2014). https://doi.org/10.1007/s00590-013-1221-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-013-1221-2

Keywords

Navigation