Double-Bundle Versus Single-Bundle Anterior Cruciate Ligament Reconstruction

Randomized Clinical and Magnetic Resonance Imaging Study With 2-Year Follow-up

1. Piia Suomalainen, MD*†,
2. Anna-Stina Moisala, MD, PhD‡,
3. Antti Paakkala, MD, PhD†,
4. Pekka Kannus, MD, PhD§ and
5. Timo Järvelä, MD, PhD‡

+Author Affiliations

1. ^†Tampere University Hospital, Tampere, Finland
2. ^‡Hatanpää Hospital, Tampere, Finland
3. ^§UKK Institute, Tampere, Finland
4. Investigation performed at Tampere University Hospital, Tampere, Finland

1. ↵* Piia Suomalainen, MD, Teiskontie 35, 33520 Tampere, Finland (e-mail:piia.suomalainen@uta.fi).

1. Presented at the 36th annual meeting of the AOSSM, Providence, Rhode Island, July 2010.

Abstract

Background: One aspect of the debate over the reconstruction of the anterior cruciate ligament is whether it should be carried out with the single-bundle or double-bundle technique.

Hypothesis: The double-bundle technique results in fewer graft failures than the single-bundle technique in anterior cruciate ligament reconstruction.

Study Design: Randomized controlled trial; Level of evidence, 1.

Methods: A total of 153 patients were prospectively randomized into 2 groups of anterior cruciate ligament reconstruction with hamstring autografts using aperture interference screw fixation: single-bundle technique (SB group, n = 78) and double-bundle technique (DB group, n = 75). The evaluation methods were clinical examination, KT-1000 arthrometric measurement, the International Knee Documentation Committee (IKDC) and the Lysholm knee scores, and magnetic resonance imaging (MRI) evaluation. All of the operations were performed by 1 experienced orthopaedic surgeon, and all clinical assessments were made by 2 blinded and independent examiners. A musculoskeletal radiologist blinded to the clinical data made the MRI interpretation.

Results: There were no differences between the study groups preoperatively. Ninety percent of patients (n = 138) were available at a minimum 2-year follow-up (range, 24-37 months). Eight patients (7 in the SB group and 1 in the DB group) had graft failure during the follow-up and had anterior cruciate ligament revision surgery (P = .04). In addition, 7 patients (5 in the SB group and 2 in the DB group) had an invisible graft on the MRI assessment at the 2-year follow-up. Also, the anteromedial bundle was partially invisible in 2 patients and the posterolateral bundle in 9 patients. Together, the total number of failures and invisible grafts were significantly higher in the SB group (12 patients, 15%) than the DB group (3 patients, 4%) (P = .024). No significant group differences were found in the knee scores or stability evaluations at the follow-up.

Conclusion: This 2-year randomized trial showed that the revision rate of the anterior cruciate ligament reconstruction was significantly lower with the double-bundle technique than that with the single-bundle technique. However, additional years of follow-up are needed to reveal the long-term results.

For further information: http://ajs.sagepub.com/content/39/8/1615.abstract