Progression of osteoarthritis after double- and single-bundle anterior cruciate ligament reconstruction

Abstract

Background: No consensus has been reached on the advantages of double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) over the single-bundle (SB) technique, particularly with respect to the prevention of osteoarthritis (OA) after ACLR.

Purpose: To evaluate whether DB ACLR has any advantages in the prevention of OA or provides better stability and function after ACLR compared with the SB technique.

Study design: Randomized controlled trial; Level of evidence, 2.

Methods: A total of 130 patients with an ACL injury in one knee were prospectively randomized into a DB group (n = 65) or an SB group (n = 65). For the radiologic evaluation, we determined the degree of OA based on the Kellgren-Lawrence grade before the operation and at the time of the final follow-up and determined the number of patients with progression of OA more than one grade from pre- to postoperation. We evaluated the stability results using the Lachman and pivot-shift tests and stress radiography. We also compared the functional outcomes based on the Lysholm knee score, Tegner activity score, and International Knee Documentation Committee (IKDC) subjective scale.

Results: Six patients (4 in the DB group and 2 in the SB group) suffered graft failure during the follow-up and had ACL revision surgery (P = .06). A total of 112 patients were observed for a minimum of 4 years (DB group, n = 52; SB group, n = 60). Five patients (9.6%) in the DB group and 6 patients (10%) in the SB group had more advanced OA at the final follow-up (P = .75). All patients recovered full range of motion within 6 months from surgery. Stability results of the Lachman test, pivot-shift test, and the radiographic stability test failed to reveal any significant intergroup differences (P = .37, .27, and .67, respectively). In the pivot-shift result, the DB group had 4 patients with grade 2 and the SB group had 3 patients with grade 2 (P = .27). Clinical outcomes, including Lysholm knee and Tegner activity scores, were similar in the 2 groups. Statistical significance was achieved only for the IKDC subjective scale (78.2 in DB group vs 73.1 in SB group; P = .03).

Conclusion: The DB technique, compared with SB, was not more effective in preventing OA and did not have a more favorable failure rate. Although the DB ACLR technique produced a better IKDC subjective scale result than did the SB ACLR technique, the 2 modalities were similar in terms of clinical outcomes and stability after a minimum 4 years of follow-up.

Keywords: anterior cruciate ligament; double bundle; osteoarthritis; reconstruction; single bundle.