Clinical outcomes of anatomical single-bundle versus double-bundle anterior cruciate ligament reconstruction: A systematic review and meta-analysis.

Abstract

Single-bundle (SB) and double-bundle (DB) are the primary techniques used for anterior cruciate ligament (ACL) reconstruction. Several studies have compared the outcomes for SB versus DB reconstruction; however, the evidence is inconclusive regarding anatomical ACL reconstruction. We conducted a systematic review and meta-analysis by searching the CENTRAL and MEDLINE databases for interventional and observational studies published between May 2016 and December 2023 comparing the clinical outcomes of anatomical SB and anatomical DB ACL reconstruction. The minimum follow-up period was at least 24 months postoperatively. Random effects models were used to estimate summary risk ratios (RRs), mean differences (MDs), and 95 % confidence intervals (CIs) for the association between SB and DB reconstruction and the clinical outcomes of re-rupture, pivot-shift test, anterior laxity, graft failure, Lysholm score, Knee Injury and Osteoarthritis Outcome Score, Tegner activity scale, meniscus tear, osteoarthritis change, and complications. After screening, 20 articles (11 interventional studies (n = 664 patients); 9 observational studies (n = 1866 patients)) were included in this meta-analysis. Compared to SB reconstruction, DB reconstruction demonstrated significantly lower residual pivot-shift test (RR: 0.42; 95 % CI: 0.30-0.60, p < 0.01) and higher Lysholm score (MD: 1.94; 95 % CI: 0.24-3.64, p = 0.03) in observational studies. In interventional studies, similar trends were observed for pivot-shift test (RR: 0.60; 95 % CI: 0.32-1.10, p = 0.10) and Lysholm score (MD: 0.81; 95 % CI: -1.48-3.10, p = 0.49), but these differences were not statistically significant. No statistically significant differences were found for other outcomes in either study category. Interventional studies found no significant differences between anatomical SB and DB ACL reconstruction. Observational studies suggested fewer pivot-shift and slightly higher Lysholm scores with DB; however, these findings were susceptible to bias, showed limited clinical relevance, and lacked consistent replication, suggesting that the evidence remains inconclusive.