Lower Rates of Osteoarthritis Progression and Improved Knee Stability Are Observed With the Double-Bundle Versus...

To compare osteoarthritis (OA) progression, graft rerupture rates, and posterior tibial translation following single-bundle (SB) versus double-bundle (DB) posterior cruciate ligament reconstruction (PCLR).

A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with PubMed, Scopus, and Embase databases searched from inception through March 2025. Clinical studies reporting OA development and/or progression following SB and DB PCLR with ≥2-year follow-up were included. Exclusion criteria included nonclinical studies, revision PCLR, concomitant anterior cruciate ligament injuries, pediatric populations, and studies lacking OA outcomes. Posterior tibial translation measured by KT-2000 arthrometer, patient-reported outcomes, graft reruptures, and complications were recorded when available. Quality assessment was performed using the Methodological Index for Non-Randomized Studies criteria.

A total of 14 clinical studies comprising 515 patients met the inclusion criteria, with 387 undergoing SB and 128 undergoing DB PCLR. In the SB group, 286 patients were male (73.9%) and 101 female (26.1%), compared with 104 males (81.3%) and 24 females (18.7%) in the DB group. Mean age ranged from 26.5 to 32.5 years in the SB group and 27.0 to 33.5 years in the DB group. Mean follow-up ranged from 24 to 148.2 months for SB PCLR and 24 to 153.4 months for DB PCLR. OA development ranged from 0% to 59.1% in the SB group and 0% to 31.3% in the DB group. OA progression was reported in 0% to 18.2% of SB cases, while only 1 study reported progression to OA (13.2%) following DB PCLR. Postoperative side-to-side differences in posterior tibial translation measured by KT-2000 arthrometer ranged from 1.1 to 9.1 mm in the SB group and 0.7 to 5.0 mm in the DB group. Included studies reported improved postoperative outcomes in the 2 study groups based on Lysholm, International Knee Documentation Committee, and Tegner scores. The proportion of knees graded as normal or nearly normal (International Knee Documentation Committee grades A and B) ranged from 57.9% to 94.1% in SB and 81.3% to 100% in DB cohorts. Reported complication rates ranged from 0% to 24.3% in SB and 0% to 15.8% in DB groups. Graft reruptures occurred in up to 17.4% of SB cases, while no reruptures were reported in the DB group.

OA development was reported following both techniques, with SB technique showing higher rates of OA development and progression. DB PCLR was associated with lower OA progression, improved posterior knee stability, and a higher proportion of normal or nearly normal postoperative International Knee Documentation Committee grades compared with SB PCLR.

Level IV, systematic review of Level II to IV studies.