Clinical outcomes of double- vs single-bundle anterior cruciate ligament reconstruction: A systematic review of randomized control trials

Authors

  • J. Kongtharvonskul,

    1. Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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  • J. Attia,

    1. Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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  • S. Thamakaison,

    1. Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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  • C. Kijkunasathian,

    1. Department of Orthopaedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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  • P. Woratanarat,

    1. Department of Orthopaedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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  • A. Thakkinstian

    Corresponding author
    • Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Corresponding author: Ammarin Thakkinstian, PhD, Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Rama VI Road, Rachatevi, Bangkok 10400, Thailand. Tel: 6622011762, Fax: 6622011284, E-mail: raatk@mahidol.ac.th

Abstract

Clinical outcomes of anterior cruciate ligament (ACL) reconstruction with double-bundle and single-bundle techniques are still controversial. We therefore performed a systematic review to compare postoperative outcomes between the two techniques. Randomized control trials comparing the outcomes between the two techniques were identified from Medline and EMBASE since inception to April 27, 2011. Data were independently extracted by two reviewers. Thirteen of 318 studies were eligible; 9, 11, 7, and 8 studies were pooled for rotation, translation, function, and complication outcomes, respectively. The double-bundle technique was approximately four times (95% CI: 2.65, 11.99) and two times (95% CI: 1.16, 5.21) more likely to show a normal pivot shift and normal International Knee Documentation Committee (IKDC) grading compared with the single-bundle technique. However, there were nonsignificant differences in KT grading (OR = 1.66, 95% CI: 0.77, 3.82), IKDC score (0.29, 95% CI: −1.17, 1.75), Lysholm knee score (−0.87, 95% CI: −2.66, 0.93), Tegner activity score (0.37, 95% CI: −0.05, 0.79), and complications (OR = 1.11, 95% CI: 0.48, 2.57). Heterogeneity was present in some outcomes but there was no evidence of publication bias for any outcome. The double-bundle may be better than the single-bundle ACL reconstruction technique in rotational stability but not for function, translation, and complications.

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