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Prospective Clinical Comparisons of Anatomic Double-Bundle Versus Single-Bundle Anterior Cruciate Ligament Reconstruction Procedures in 328 Consecutive Patients

Eiji Kondo, MD, PhD^*, Kazunori Yasuda, MD, PhD^*,, Hirotaka Azuma, MD, PhD, Yoshie Tanabe, PhD, RPT^* and Tomonori Yagi, MD, PhD

From the ^* Department of Sports Medicine and Joint Reconstruction Surgery, Hokkaido University School of Medicine, Department of Orthopaedic Surgery, Sapporo City General Hospital, and Department of Orthopaedic Surgery, Yamanote-dori Yagi Hospital, Sapporo, Japan

Address correspondence to Kazunori Yasuda, MD, PhD, Department of Sports Medicine and Joint Reconstruction Surgery, Hokkaido University School of Medicine, Kita-15 Nishi-7, Kita-ku, Sapporo 060-8638, Japan (e-mail: yasukaz{at}med.hokudai.ac.jp).

Background: Several trials have been conducted to compare the clinical results between anatomic double-bundle and single-bundle anterior cruciate ligament (ACL) reconstruction procedures. In these studies, however, the number of patients was insufficient to compare the clinical results of the 2 procedures.

Hypothesis: The anatomic double-bundle procedure may be significantly better concerning the anterior laxity and the pivot-shift test than the single-bundle procedure, while there may be no significant differences in the other clinical evaluations and the intra-operative and postoperative complications between the 2 procedures.

Study Design: Cohort study; Level of evidence, 2.

Methods: Three hundred and twenty-eight patients with unilateral ACL reconstruction using hamstring autografts were divided into 2 groups. The first 157 consecutive patients underwent single-bundle reconstruction and the remaining 171 patients underwent anatomic double-bundle reconstruction. Concerning all background factors, there were no statistical differences between the 2 groups. Each patient was examined 2 years after surgery.

Results: No serious complications were experienced in either group. The anterior laxity was significantly less in the double-bundle reconstruction (mean, 1.2 mm) than in the single-bundle reconstruction (mean, 2.5 mm). In the pivot-shift test, the double bundle (+ indication, 16%; ++, 3%) was significantly better than the single bundle (+ result, 37%; ++, 12%). The mean Lysholm score averaged 96.5 points and 97.3 points in single-bundle and double-bundle reconstructions, respectively, while the International Knee Documentation Committee evaluation showed that 90 and 110 patients, respectively, were evaluated as rank A (no significant difference between groups). There were no significant differences in the other clinical evaluations and the complications between the 2 procedures.

Conclusions: The postoperative anterior and rotational stability after the anatomic double-bundle ACL reconstruction was significantly better than that after the single-bundle reconstruction, although there were no significant differences between the 2 procedures concerning the complications and the clinical evaluations.

Key Words: anterior cruciate ligament • anatomic double-bundle reconstruction • hamstring tendon autograft • posterolateral bundle • clinical outcome