Single-bundle versus double-bundle anterior cruciate ligament reconstruction: an up-to-date meta-analysis

Li, Xue; Xu, Changpeng; Song, Jingyu; Jiang, Nan; Yu, Bin

doi:10.1007/s00264-012-1651-1

Cited by 71 publications

(84 citation statements)

References 49 publications

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“…Although an earlier meta-analysis did not find a clinical difference between double-bundle and single-bundle ACL reconstructions in terms of knee laxity [32], more recent meta-analyses have shown improved joint stability with double-bundle procedures [26,53]. Better control of tibial rotation might be expected to give a better functional outcome and therefore a potentially higher rate of return to pre-injury activity, but to date, so-called anatomical reconstruction has not been shown to result in higher activity levels [53].…”

Section: Discussionmentioning

confidence: 99%

Return to sport following anterior cruciate ligament reconstruction

Feller

Webster

2012

International Orthopaedics (SICOT)

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Section: Discussionmentioning

confidence: 99%

Return to sport following anterior cruciate ligament reconstruction

Feller

Webster

2012

International Orthopaedics (SICOT)

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“…Ameliyat öncesi ÖÇB yırtığı olan ekstremitede artan tibial rotasyonun anatomik çift demet ÖÇBR dan sonra azaldığı ve sağlam ekstremite ile karşı-laştırıldığında tibial rotasyonda fark olmadığı bildirilmiştir [17]. Onyedi randomize kontrollü çalışmada 1381 hastayı içeren yeni bir metaanalizde çift demet ÖÇBR ile daha az greft yetmezliği riski, daha az pivot şift testi pozitifliği, daha düşük KT-1000 artrometre ölçümü, daha az diz ekstansiyon kısıtlılığı ve daha yük-sek subjektif IKDC skoru olduğu, Lysholm skoru, diz ekstansör pik torku, diz fleksiyon kısıtlılığı ve objektif IKDC skoru bakımın-dan tek demet ÖÇBR ile fark olmadığı bildirilmiştir [18]. Tek demet ÖÇBR ile ilgili çalışmaların önemli bir kısmı femoral tünelin transtibial teknikle oluşturulduğu anatomik olmayan greft yerleşimlerine aittir [8,10].…”

Section: Introductionunclassified

Early Results of Anatomic Double Bundle Anterior Cruciate Ligament Reconstruction

Karakaplan¹,

Elmalı²,

Topgül³

et al. 2015

Ann Clin Anal Med

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ÖzetAmaç: Ön çapraz bağ (ÖÇB) rekonstrüksiyonunda amaç, normal anatomik yapıyı ve diz fonksiyonunu yeniden sağlamaktır. Geleneksel tek demet ÖÇB rekonstrüksiyonu (ÖÇBR) sonrası hastaların önemli bir kısmında instabilite şi-kayetleri devam etmektedir. Anatomik çift demet ÖÇBR, doğal anatomiye daha yakın olarak dizin normal kinematiklerini yeniden sağlıyabilir. Bu ça-lışmada çift demet ÖÇBR yaptığımız hastalarımızın erken dönem sonuçları-nı değerlendirmeyi amaçladık. Gereç ve Yöntem: Haziran 2009 ile Mart 2010 tarihleri arasında kliniğimizde otojen hamstring greftleri ile anatomik çift demet ÖÇBR yapılan 20 hasta, prospektif olarak Cincinnati, IKDC ve Lysholm skorları ile klinik olarak ve kas güçleri için Cybex II dinamometresi ile değer-lendirildiler. Bulgular: Ortalama takip süresi 17.8 ay (13-21 ay) dır. Hastaların Cincinnati, IKDC ve Lysholm skorları sırasıyla preop 18.1, 39.3 ve 39.8 iken post op 27.2, 76,3 ve 86.3 e yükselmiştir. Son kontrollerinde IKDC skorlarına göre hastaların 17 si (%85) A (mükemmel) ve B (iyi) grubunda 3'ü C (yeterli) grubunda yer aldı. Kuadriseps ve hamstring kas gruplarına ait güç ölçüm-lerinde hastaların ameliyat edilen dizleri ile sağlam dizleri arasında anlamlı fark bulunmadı. Tartışma: Hamstring tendonları ile femoral askı yöntemi kullanılarak yapılan çift demet ÖÇBR tatmin edici bir yöntemdir. Tekniğin klinik neticeyi iyileştirme, diz biyomekaniğini daha iyi restore etme ve dejenerasyonu önleme açısından yararlarını belirlemek için daha geniş sayıda, karşılaştır-malı ve uzun dönem çalışmalar gerekmektedir. Anahtar KelimelerÖn Çapraz Bağ; Diz; Rekonstrüksiyon; Çift Demet Abstract Aim: The goal in anterior cruciate ligament reconstruction (ACLR) is to restore the normal anatomic structure and function of the knee. In the significant proportion of patients after the traditional single-bundle ACLR, complaints of instability still continue. Anatomic double bundle ACLR may provide normal kinematics in knees, much closer to the natural anatomy. The aim of this study is to clinically assess the early outcomes of our anatomical double bundle ACLR. Material and Method: In our clinic between June 2009 and March 2010, performed the anatomic double bundle ACLR with autogenous hamstring grafts 20 patients were evaluated prospectively with Cincinnati, IKDC and Lysholm scores and in clinically for muscle strength and with Cybex II dynamometer. Results: The mean follow-up is 17.8 months (13-21 months). Patients' scores of Cincinnati, IKDC and Lysholm were respectively, preoperative 18.1, 39.3 and 39.8, while the post-op increased to 27.2, 76.3 and 86.3. In their last check, 17 percent of the patients according to IKDC scores (85%) A (excellent) and B (good) group and 3 patients took place as C (adequate) group. The power measurements of quadriceps and hamstring muscle groups of patients who underwent surgery showed no significant difference compared with the intact knees. Discussion: Double-bundle ACL reconstruction is a satisfactory method. There is a need comparative, long-term studies in large...

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Comment on Li et al.: Single-bundle versus double-bundle anterior cruciate ligament reconstruction: an up-to-date meta-analysis

Dong

Chen

Fan³

et al. 2013

International Orthopaedics (SICOT)

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Dear Editor,In International Orthopaedics, Xue Li and his colleagues published a meta-analysis conducted to compare the efficacy of arthroscopic single-bundle and double-bundle anterior cruciate ligament reconstruction, and they did very well [1]. However, the meta-analysis has brought a few questions to our minds that we would like to convey to the authors:1. Publication language was limited to English in the metaanalysis. Therefore, the authors should mention the potential importance of language bias in the limitations of their meta-analysis. 2. In the article, the authors used the odds ratio (OR) for dichotomous outcomes to report the risk value rather than relative risk (RR). As there are 17 randomised controlled trials (RCTs) included, RR can report the real risk value better than OR. Therefore, we suggest that RR should be used to report the risk value in this article. 3. It is not sufficient that publication bias was only assessed by visual examination of a funnel plot. Funnel plot symmetry should be further assessed by statistical tests (e.g. Egger's linear regression test or Begg's rank correlation test). Moreover, in the meta-analysis, publication bias was only assessed for KT1000 arthrometer measurements. Actually, publication bias should be assessed for other comparisons (such as Lysholm score, objective International Knee Documentation Committee score, negative pivot-shift test). Therefore, publication bias may be present, distorting the meta-analysis. 4.It is not appropriate that summary OR and standard mean difference (SMD) estimates with corresponding 95 % confidence intervals were derived by using the method of Mantel-Haenszel (M-H) or inverse variance (IV) with the assumptions of a random effects model. However, studies should be combined by using the DerSimonian and Laird random effects model, which considers both within-and between-study variations [2]. 5. The difference in the follow-up periods between studies was large, which may cause heterogeneity. Subgroup analysis was performed by stratifying the available data according to follow-up periods. To make the article more credible, the authors should analyse the effect of single-bundle versus double-bundle anterior cruciate ligament reconstruction according to different ages and sexes on account of the limitation of the studies included. Moreover, further highquality RCTs based on larger sample sizes are still needed. 6. Evidence indicated that only the larger study should be included for analysis when some publications contained the same or overlapping data. There are two studies performed by Järvelä et al. [3,4] Moreover, further high-quality RCTs based on larger sample sizes are still needed to compare arthroscopic single-bundle and double-bundle anterior cruciate ligament reconstructions. We believe that our remarks will contribute to more accurate elaboration of the results presented by Li et al.

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Single-bundle versus double-bundle anterior cruciate ligament reconstruction: an up-to-date meta-analysis

Abstract: Considering the more favourable outcomes of graft failures, knee joint stability and knee joint function in double-bundle reconstruction, we concluded that arthroscopic double-bundle reconstruction should be considered as the primary treatment in ACL reconstruction.

Cited by 71 publications

References 49 publications

Return to sport following anterior cruciate ligament reconstruction

Return to sport following anterior cruciate ligament reconstruction

Early Results of Anatomic Double Bundle Anterior Cruciate Ligament Reconstruction

Comment on Li et al.: Single-bundle versus double-bundle anterior cruciate ligament reconstruction: an up-to-date meta-analysis

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