Biomechanical comparison of single-bundle versus double-bundle anterior cruciate ligament reconstruction: a meta-analysis

Abstract

Background: Of the many issues regarding surgical techniques related to anterior cruciate ligament reconstruction (ACLR), single-bundle (SB) or double-bundle (DB) ACLR is one of the most debated topics. However, it is unclear which of the techniques yields better outcomes after ACLR for ACL injury. The purpose of this meta-analysis was to compare the benefits of SB versus DB ACLR in terms of biomechanical outcomes. Methods: The electronic databases MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and Scopus were searched for relevant articles comparing the outcomes of SB-ACLR versus DB-ACLR that were published until November 2019. Results: Seventeen biomechanical studies were included. The anterior laxity measured using the anterior drawer test showed significantly better results in DB-ACLR when compared with SB-ACLR. In addition, outcomes of the anterior tibial translation test under a simulated pivot shift presented with better results at low flexion and 30°in DB-ACLR, compared with SB-ACLR. However, there were no significant biomechanical differences between the groups in internal rotation. Conclusions: The present study demonstrated that both techniques for ACLR are associated with restoration of normal knee kinematics. DB-ACLR is superior to SB-ACLR in terms of restoration of anteroposterior stability. However, which technique yields better improvement in internal rotation laxity, and internal rotation laxity under a simulated pivot shift at a specific angle, remains unclear. Level of evidence: This is a level II meta-analysis.

The Statistical Fragility of Single-Bundle vs Double-Bundle Autografts for ACL Reconstruction: A Systematic Review of Comparative Studies

“…The principle behind this technique is to re-create the native ACL anatomy and restore the proper tension pattern of each bundle. Although biomechanical studies 29 , 34 have shown the technique to be superior, many studies 7 , 10 , 25 , 27 , 29 , 43 , 46 , 49 have shown no significant difference with respect to subjective clinical outcomes. Despite the potential benefits of double-bundle ACLR, single-bundle anatomic ACLR remains the preferred technique for surgeons in the United States and globally.…”

Biomechanical Difference between Conventional Transtibial Single-Bundle and Anatomical Transportal Double-Bundle Anterior Cruciate Ligament Reconstruction Using Three-Dimensional Finite Element Model Analysis

“…In the same study, the maximum ATT was observed in the ACL intact knee at 30° flexion and after anatomical DB reconstruction [ 28 ]. In some other studies, DB ACL reconstructions have shown closer biomechanics to an intact knee compared with SB reconstructions [ 8 , 14 , 29 ]. Tsai et al also showed similar result to our study in that the ATT after DB ACL reconstruction was smaller at a high flexion angle than after SB ACL reconstruction [ 14 ].…”

“…In conventional single-bundle (SB) ACL reconstruction, the tunnels are made in the posterolateral (PL) tibial footprint and the anteromedial (AM) femoral footprint, resulting in a non-anatomical and more vertical direction than the native ACL, which cannot restore rotatory laxity [ 3 , 4 ]. Anatomical double-bundle (DB) ACL reconstruction shows superior biomechanical results, including both anterior and rotatory stability, compared to conventional non-anatomical SB ACL reconstruction [ 5 , 6 , 7 , 8 ].…”

A Modified Anatomic Transtibial Double-Bundle Anterior Cruciate Ligament Reconstruction Provides Reliable Bone Tunnel Positioning

“…Biomechanically, it provides better valgus and internal rotation kinematics and anterior translational stability than the single-bundle reconstruction. 1 , 2 , 3 Clinical comparative studies provide several results from the equivalence of the 2 different reconstructions 4 , 5 , 6 to the superiority of double-bundle reconstruction in regard to rotational stability tests, revision reconstruction rate, or further osteoarthritis incidence rate. 7 , 8 , 9 …”