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Long-Term Outcomes Following Anatomic Double-Bundle Versus Single-Bundle Anterior Cruciate Ligament Reconstruction

Dlshad Qadir1,2, Ninni Sernert2,3, Lars Rostgard-Christensen4

  • 1Department of Orthopaedics, NU-Hospital Group, Uddevalla, Sweden.

Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association
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Anterior cruciate ligament (ACL) reconstruction using double-bundle (DB) or single-bundle (SB) techniques showed similar long-term clinical outcomes and no difference in osteoarthritis development after 14 years. Both surgical methods provided significant improvements in knee function.

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Area of Science:

  • Orthopedic surgery
  • Sports medicine
  • Biomechanical research

Background:

  • Anterior cruciate ligament (ACL) tears are common knee injuries, often requiring surgical reconstruction.
  • Anatomic single-bundle (SB) and double-bundle (DB) techniques are surgical options for ACL reconstruction.
  • Long-term comparative data on clinical outcomes and osteoarthritis development between these techniques are crucial for surgical decision-making.

Purpose of the Study:

  • To compare the 14-year clinical and radiographic outcomes of anatomic ACL reconstruction using double-bundle (DB) versus single-bundle (SB) techniques.
  • To specifically evaluate the long-term development of osteoarthritis after ACL reconstruction with both methods.

Main Methods:

  • A randomized controlled trial involving 105 patients undergoing anatomic ACL reconstruction with hamstring autografts.
  • Patients were randomized to either the DB group (n=53) or SB group (n=52).
  • Clinical assessments included subjective and objective measures, laxity testing, functional tests, and radiographic evaluation for osteoarthritis at an average 14-year follow-up.

Main Results:

  • Sixty-four patients completed the 14-year follow-up.
  • No significant differences were observed between the DB and SB groups in pivot-shift, Lachman grades, laxity, functional tests (hop, range of motion, Lysholm, Tegner), or patient-reported outcomes (KOOS).
  • Radiographic assessment revealed no significant differences in osteoarthritis development (Ahlbäck, Fairbank, Kellgren-Lawrence grades) between the two surgical techniques.

Conclusions:

  • Anatomic double-bundle ACL reconstruction does not demonstrate superiority over anatomic single-bundle reconstruction regarding clinical outcomes or the development of knee osteoarthritis at 14 years.
  • Both techniques lead to significant improvements in knee function compared to preoperative status.
  • The choice between anatomic DB and SB techniques may not significantly impact long-term osteoarthritis progression.