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Meta-Analysis
. 2012 Nov 14;11(11):CD008413.
doi: 10.1002/14651858.CD008413.pub2.

Double-bundle versus single-bundle reconstruction for anterior cruciate ligament rupture in adults

Thavatchai Tiamklang  1 , Sermsak Sumanont, Thanit Foocharoen, Malinee Laopaiboon
Affiliations
Meta-Analysis

Double-bundle versus single-bundle reconstruction for anterior cruciate ligament rupture in adults

Thavatchai Tiamklang et al. Cochrane Database Syst Rev. .

Abstract

Background: Arthroscopic reconstruction for anterior cruciate ligament rupture is a common orthopaedic procedure. One area of controversy is whether the method of double-bundle reconstruction, which represents the 'more anatomical' approach, gives improved outcomes compared with the more traditional single-bundle reconstruction.

Objectives: To assess the effects of double-bundle versus single-bundle for anterior cruciate ligament reconstruction in adults with anterior cruciate ligament deficiency.

Search methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (to February 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 2), MEDLINE (1966 to February week 3 2012) and EMBASE (1980 to 2012 Week 8). We also searched trial registers, conference proceedings, and contacted authors where necessary.

Selection criteria: Randomised and quasi-randomised controlled clinical trials comparing double-bundle versus single-bundle reconstruction for anterior cruciate ligament (ACL) rupture in adults.

Data collection and analysis: Two review authors independently selected articles, assessed risk of bias and extracted data. We contacted investigators to obtain missing information. Where appropriate, results of comparable studies were pooled.

Main results: Seventeen trials were included. These involved 1433 people, mostly young physically active adults. All included trials had methodological weaknesses and were at risk of bias, notably selection bias from inadequate or lack of allocation concealment. Data for pooling individual outcomes were available for a maximum of nine trials and 54% of participants.There were no statistically or clinically significant differences between double-bundle and single-bundle reconstruction in the subjective functional knee scores (subjective IKDC score, Tegner activity score, Lysholm score) in the intermediate (six months up to two years since surgery) or long term (two to five years from surgery). For example, the long term results for the Lysholm score (0 to 100: best score) were: mean difference (MD) 0.12, 95% confidence interval (CI) -1.50 to 1.75; 5 trials, 263 participants). The only trial reporting on long term knee pain found no statistically significant differences between the two groups. There were no significant differences between the two groups in adverse effects and complications (e.g. infection reported by nine trials (7/285 versus 7/393; risk ratio (RR) 1.14, 95% CI 0.46 to 2.81); graft failure reported by six trials (1/169 versus 4/185; RR 0.45; 95% CI 0.07 to 2.90).Limited data from five trials found a better return to pre-injury level of activity after double-bundle reconstruction (147/162 versus 208/255; RR 1.15, 95% CI 1.07 to 1.25). At long term follow-up, there were statistically significant differences in favour of double-bundle reconstruction for IKDC knee examination (normal or nearly normal categories: 325/344 versus 386/429; RR 1.05, 95% CI 1.01 to 1.08; 9 trials), knee stability measured with KT-1000 arthrometer (MD -0.74 mm, 95% CI -1.10 to -0.37; 5 trials, 363 participants) and rotational knee stability tested by the pivot-shift test (normal or nearly normal categories: 293/298 versus 382/415; RR 1.06, 95% CI 1.02 to 1.09; 9 trials). There were also statistically significant differences in favour of double-bundle reconstruction for newly occurring meniscal injury (9/240 versus 24/358; RR 0.46, 95% CI 0.23 to 0.92; 6 trials) and traumatic ACL rupture (1/120 versus 8/149; RR 0.17, 95% CI 0.03 to 0.96; 3 trials). There were no statistically significant differences found between the two groups in range of motion (flexion and extension) deficits.

Authors' conclusions: There is insufficient evidence to determine the relative effectiveness of double-bundle and single-bundle reconstruction for anterior cruciate ligament rupture in adults, although there is limited evidence that double-bundle ACL reconstruction has some superior results in objective measurements of knee stability and protection against repeat ACL rupture or a new meniscal injury. High quality, large and appropriately reported randomised controlled trials of double-bundle versus single-bundle reconstruction for anterior cruciate ligament rupture in adults appear justified.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 Double‐bundle versus single‐bundle ACL reconstruction, Outcome 1 Subjective functional knee scores (I).
1.2
1.2. Analysis
Comparison 1 Double‐bundle versus single‐bundle ACL reconstruction, Outcome 2 Subjective functional knee scores (II).
1.3
1.3. Analysis
Comparison 1 Double‐bundle versus single‐bundle ACL reconstruction, Outcome 3 Long term knee pain.
1.4
1.4. Analysis
Comparison 1 Double‐bundle versus single‐bundle ACL reconstruction, Outcome 4 Adverse effects and complications.
1.5
1.5. Analysis
Comparison 1 Double‐bundle versus single‐bundle ACL reconstruction, Outcome 5 Return to pre‐injury level of activity / sport participation.
1.6
1.6. Analysis
Comparison 1 Double‐bundle versus single‐bundle ACL reconstruction, Outcome 6 Objective measures of knee stability (I): IKDC examination.
1.7
1.7. Analysis
Comparison 1 Double‐bundle versus single‐bundle ACL reconstruction, Outcome 7 Objective measures of knee stability (2): side‐to‐side difference.
1.8
1.8. Analysis
Comparison 1 Double‐bundle versus single‐bundle ACL reconstruction, Outcome 8 Objective measures of knee stability (3): side‐to‐side difference < 3 mm.
1.9
1.9. Analysis
Comparison 1 Double‐bundle versus single‐bundle ACL reconstruction, Outcome 9 Intraoperative stabilities.
1.10
1.10. Analysis
Comparison 1 Double‐bundle versus single‐bundle ACL reconstruction, Outcome 10 Anterior stability.
1.11
1.11. Analysis
Comparison 1 Double‐bundle versus single‐bundle ACL reconstruction, Outcome 11 Anterior stability (random‐effects meta‐analysis).
1.12
1.12. Analysis
Comparison 1 Double‐bundle versus single‐bundle ACL reconstruction, Outcome 12 Rotational stability (Pivot‐shift test).
1.13
1.13. Analysis
Comparison 1 Double‐bundle versus single‐bundle ACL reconstruction, Outcome 13 Range of motion deficit.
1.14
1.14. Analysis
Comparison 1 Double‐bundle versus single‐bundle ACL reconstruction, Outcome 14 Recurrent injury with and without re‐operation.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD008413

References

References to studies included in this review

Adachi 2004 {published data only}
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Araki 2011 {published data only}
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Misonoo 2012 {published data only}
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References to studies excluded from this review

Aglietti 2007 {published data only}
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References to studies awaiting assessment

Cermak 2011 {published data only}
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Nikolopoulos 2011 {published data only}
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Stefani 2011 {published data only}
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References to ongoing studies

DRKS00000333 {unpublished data only}
    1. Kinematics of the knee after single bundle and double bundle anterior cruciate ligament (ACL) reconstruction. A prospective randomized study. http://www.drks.de/DRKS00000333.
NCT00418964 {unpublished data only}
    1. Chan KM. Clinical trial comparing three anterior cruciate ligament reconstructive procedures. http://clinicaltrials.gov/show/NCT00418964 (accessed 12 April 2012).
NCT00529958 {unpublished data only}
    1. Mohtadi NG. Comparison of three methods for anterior cruciate ligament reconstruction. http://clinicaltrials.gov/show/NCT00529958 (accessed 12 April 2012).
NCT01025895 {unpublished data only}
    1. Anterior cruciate ligament (ACL) reconstruction: single bundle versus double bundle. http://clinicaltrials.gov/show/NCT01025895 (accessed 12 April 2012).
NCT01033188 {unpublished data only}
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NCT01319409 {unpublished data only}
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NCT01358656 {unpublished data only}
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NCT01377129 {unpublished data only}
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NCT01391650 {unpublished data only}
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References to other published versions of this review

Tiamklang 2010
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