The 10-Year Outcomes of Single- versus Double-Bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review

Single-bundle (SB) and double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) have been compared for years, and long-term outcomes of the two techniques remain inconclusive. We compared the 10-year outcomes of SB and DB reconstruction, in terms of subjective scores, knee stability, graft failure, and osteoarthritis (OA). We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials for relevant studies, without restrictions on study design, language, or publication date. The risk of bias and methodological quality were assessed using the Cochrane risk of bias tools (RoB 2 and ROBINS-I) and the Modified Coleman Methodology Score (MCMS), respectively. Reconstructions scoring at least 8 on the Anatomic ACLR Scoring Checklist (AARSC) were considered anatomic. The results were narratively summarized and graphically represented using tables and forest plots. Our search included six studies (two randomized control trials [RCTs] and four cohort studies [CSs]), comprising 222 SB and 214 DB reconstruction patients, with an average follow-up of 11.4 years. Of these, four studies achieved a methodological rating of "good" or above. Bias risk was evaluated as "some concerns" in the RCTs and "serious" in the CSs. Six, four, four, and two studies reported on subjective scores, knee stability, graft failure, and OA, respectively. Except for one study that reported a higher Lysholm score (p = 0.007) in the DB group, no group differences in subjective scores were identified. According to one study, the DB group performed better on the Lachman test (p = 0.02) and the KT-2000 arthrometer (p = 0.024 and 0.034 for pulling and back pushing, respectively). Three studies revealed higher negative rates of the pivot shift test in the DB group. The incidence of graft failure and OA were not statistically significant between the SB and DB groups. The existing evidence does not conclusively determine whether DB reconstruction provides long-term advantages over SB reconstruction. Future research with larger sample sizes and higher levels of evidence is warranted.