Top

International Orthopaedics

Published in:

Open Access 10-02-2024 | Original Paper

Double-bundle anterior cruciate ligament reconstruction resulted in better International Knee Documentation Committee objective grading at fifteen year follow-up compared to single-bundle reconstruction

Authors: Arttu Seppänen, Piia Suomalainen, Tommi Kiekara, Heikki Mäenpää, Heini Huhtala, Timo Järvelä

Published in: International Orthopaedics | Issue 4/2024

Abstract

Purpose

The aim of this prospective randomized study was to evaluate whether the use of the anatomic double-bundle (DB) method for anterior cruciate ligament (ACL) reconstruction results in better clinical outcomes and a lower incidence of graft failure compared with the anatomic single-bundle (SB) method. The hypothesis was that DB ACL reconstruction would result in a lower incidence of graft failure.

Methods

Patients were randomly assigned to either the SB group (n = 78) or the DB group (n = 75). Evaluation included clinical testing, subjective assessments, functional testing, and International Knee Documentation Committee (IKDC) objective grading. Surgical techniques were anatomic, and the rehabilitation protocol was standardized.

Results

At 15-year follow-up, information was available on 100 patients (65%), of whom 55 (36%) were accepted in the final statistical analysis. There were almost three times as many graft failures in the SB group, but the result wasn´t statistically significant. Subjective assessments, knee stability (KT -1000 and pivot shift), range of motion (ROM), and functional one leg hop test showed no statistically significant differences between the groups. However, DB ACL reconstruction resulted in better International Knee Documentation Committee objective grading (P < 0.001).

Conclusion

At the 15-year follow-up, double-bundle surgery resulted in significantly better International Knee Documentation Committee objective grading compared to single-bundle surgery.

Herzog MM, Marshall SW, Lund JL, Pate V, Mack CD, Spang JT (2017) Incidence of anterior cruciate ligament reconstruction among adolescent females in the United States, 2002 Through 2014. JAMA Pediatr 171:808–810. https://doi.org/10.1001/jamapediatrics.2017.0740CrossRefPubMedPubMedCentral

Mall NA, Chalmers PN, Moric M, Tanaka MJ, Cole BJ, Bach BR Jr et al (2014) Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med 42:2363–2370. https://doi.org/10.1177/0363546514542796CrossRefPubMed

Fujita N, Kuroda R, Matsumoto T, Yamaguchi M, Yagi M, Matsumoto A et al (2011) Comparison of the clinical outcome of double-bundle, anteromedial single-bundle, and posterolateral single-bundle anterior cruciate ligament reconstruction using hamstring tendon graft with minimum 2-year follow-up. Arthroscopy 27:906–913. https://doi.org/10.1016/j.arthro.2011.02.015CrossRefPubMed

Hussein M, van Eck CF, Cretnik A, Dinevski D, Fu FH (2012) Prospective randomized clinical evaluation of conventional single-bundle, anatomic single-bundle, and anatomic double-bundle anterior cruciate ligament reconstruction: 281 cases with 3- to 5-year follow-up. Am J Sports Med 40:512–520. https://doi.org/10.1177/0363546511426416CrossRefPubMed

Ibrahim SA, Hamido F, Al Misfer AK, Mahgoob A, Ghafar SA, Alhran H (2009) Anterior cruciate ligament reconstruction using autologous hamstring double bundle graft compared with single bundle procedures. J Bone Joint Surg Br 91:1310–1315. https://doi.org/10.1302/0301-620x.91b10.21886CrossRefPubMed

Chen H, Chen B, Tie K, Fu Z, Chen L (2018) Single-bundle versus double-bundle autologous anterior cruciate ligament reconstruction: a meta-analysis of randomized controlled trials at 5-year minimum follow-up. J Orthop Surg Res 13:50. https://doi.org/10.1186/s13018-018-0753-xCrossRefPubMedPubMedCentral

Dong Z, Niu Y, Qi J, Song Y, Wang F (2019) Long term results after double and single bundle ACL reconstruction: Is there any difference? A meta - analysis of randomized controlled trials. Acta Orthop Traumatol Turc 53:92–99. https://doi.org/10.1016/j.aott.2018.12.004CrossRefPubMedPubMedCentral

Maestro A, Herruzo I, Varillas-Delgado D, Martín-Saborido C (2021) Subjective assessment reported by patients shows differences between single-bundle and double-bundle anterior cruciate ligament reconstruction, systematic review and meta-analysis. Sci Rep 11:15385. https://doi.org/10.1038/s41598-021-94868-0CrossRefPubMedPubMedCentral

Xu M, Gao S, Zeng C, Han R, Sun J, Li H et al (2013) Outcomes of anterior cruciate ligament reconstruction using single-bundle versus double-bundle technique: meta-analysis of 19 randomized controlled trials. Arthroscopy 29:357–365. https://doi.org/10.1016/j.arthro.2012.08.024CrossRefPubMed

10.

Zhu Y, Tang RK, Zhao P, Zhu SS, Li YG, Li JB (2013) Double-bundle reconstruction results in superior clinical outcome than single-bundle reconstruction. Knee Surg Sports Traumatol Arthrosc 21:1085–1096. https://doi.org/10.1007/s00167-012-2073-8CrossRefPubMed

11.

Seppänen A, Suomalainen P, Huhtala H, Mäenpää H, Kiekara T, Järvelä T (2022) Double bundle ACL reconstruction leads to better restoration of knee laxity and subjective outcomes than single bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 30(5):1795–1808. https://doi.org/10.1007/s00167-021-06744-zCrossRefPubMed

12.

Crawford SN, Waterman BR, Lubowitz JH (2013) Long-term failure of anterior cruciate ligament reconstruction. Arthroscopy 29:1566–1571. https://doi.org/10.1016/j.arthro.2013.04.014CrossRefPubMed

13.

Sanders TL, Pareek A, Hewett TE, Levy BA, Dahm DL, Stuart MJ, Krych AJ (2017) Long-term rate of graft failure after ACL reconstruction: a geographic population cohort analysis. Knee Surg Sports Traumatol Arthrosc 25:222–228. https://doi.org/10.1007/s00167-016-4275-yCrossRefPubMed

14.

Cronström A, Tengman E, Häger CK (2023) Return to Sports: A Risky Business? A Systematic Review with Meta-Analysis of Risk Factors for Graft Rupture Following ACL Reconstruction. I Sports Med 53:91–110. https://doi.org/10.1007/s40279-022-01747-3CrossRefPubMed

15.

Zhao D, Pan JK, Lin FZ, Luo MH, Liang GH, Zeng LF, Huang HT, Han YH, Xu NJ, Yang WY, Liu J (2023) Risk Factors for Revision or Rerupture After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Am J Sports Med 51:3053–3075. https://doi.org/10.1177/03635465221119787CrossRefPubMed

16.

Hurley ET, Mojica ES, Kanakamedala AC, Meislin RJ, Strauss EJ, Campbell KA, Alaia MJ (2022) Quadriceps tendon has a lower re-rupture rate than hamstring tendon autograft for anterior cruciate ligament reconstruction - A meta-analysis. J isakos 7:87–93. https://doi.org/10.1016/j.jisako.2021.10.001CrossRefPubMed

17.

Järvelä S, Kiekara T, Suomalainen P, Järvelä T (2017) Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective randomized study with 10-year results. Am J Sports Med 45(11):2578–2585. https://doi.org/10.1177/0363546517712231CrossRefPubMed

18.

American Orthopaedic Society for Sports Medicine (2000) IKDC KNEE FORMS. https://www.sportsmed.org/uploads/main/files/general/IKDC/AOSSM_IKDC_English_US.pdf. Accessed 27 November 2023.

19.

Järvelä T (2007) Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective, randomize clinical study. Knee Surg Sports Traumatol Arthrosc 15(5):500–507. https://doi.org/10.1007/s00167-006-0254-zCrossRefPubMed

20.

Rai SK, Yazdany J, Fortin PR, Aviña-Zubieta JA (2015) Approaches for estimating minimal clinically important differences in systemic lupus erythematosus. Arthritis Res Ther 17:143. https://doi.org/10.1186/s13075-015-0658-6CrossRefPubMedPubMedCentral

21.

Balasingam S, Karikis I, Rostgård-Christensen L, Desai N, Ahldén M, Sernert N et al (2022) Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Is Not Superior to Anatomic Single-Bundle Reconstruction at 10-Year Follow-up: A Randomized Clinical Trial. Am J Sports Med 50:3477–3486. https://doi.org/10.1177/03635465221128566CrossRefPubMed

22.

Mao Z, Wang J, Wang Y, Jiang D, Wang X, Wang H, Lin L, Liu Y, Zeng L, Yu J (2021) Double-bundle anterior cruciate ligament reconstruction technique has advantages in chondroprotection and knee laxity control compared with single-bundle technique: A long-term follow-up with a minimum of 12 years. Knee Surg Sports Traumatol Arthrosc 29:3105–3114. https://doi.org/10.1007/s00167-020-06350-5CrossRefPubMed

23.

Suomalainen P, Moisala AS, Paakkala A, Kannus P, Järvelä T (2011) Double-bundle versus single-bundle anterior cruciate ligament reconstruction: randomized clinical and magnetic resonance imaging study with 2-year follow-up. Am J Sports Med 39(8):1615–1622. https://doi.org/10.1177/0363546511405024CrossRefPubMed

24.

Suomalainen P, Järvelä T, Paakkala A, Kannus P, Järvinen M (2012) Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective randomized study with 5-year results. Am J Sports Med 40(7):1511–1518. https://doi.org/10.1177/0363546512448177CrossRefPubMed

25.

Suomalainen P, Kiekara T, Moisala AS, Paakkala A, Kannus P, Järvelä T (2014) Effect of tunnel placements on clinical and magnetic resonance imaging findings 2 years after anterior cruciate ligament reconstruction using the double-bundle technique. Open Access J Sports Med 5:197–203. https://doi.org/10.2147/oajsm.s62050CrossRefPubMedPubMedCentral

26.

Suomalainen P, Moisala AS, Paakkala A, Kannus P, Järvelä T (2013) Comparison of tunnel placements and clinical results of single-bundle anterior cruciate ligament reconstruction before and after starting the use of double-bundle technique. Knee Surg Sports Traumatol Arthrosc 21(3):646–653. https://doi.org/10.1007/s00167-012-1981-yCrossRefPubMed

27.

Mohtadi NG, Chan DS (2019) A randomized clinical trial comparing patellar tendon, hamstring tendon, and double-bundle ACL reconstructions: Patient-reported and clinical outcomes at 5-year follow-up. J Bone Joint Surg Am 101:949–960. https://doi.org/10.2106/jbjs.18.01322CrossRefPubMed

28.

Xu Z, Ma L, Li R (2023) Anatomic Double-Bundle and Single-Bundle Reconstructions Yield Similar Outcomes Following Anterior Cruciate Ligament Rupture: A Systematic Review and Meta-Analysis. Arthroscopy. https://doi.org/10.1016/j.arthro.2023.05.017CrossRefPubMedPubMedCentral

29.

Eliya Y, Qureshi AR, Kay J, Nagai K, Hoshino Y, de Sa D (2023) Anatomical double-bundle anterior cruciate ligament reconstruction moderately improved tegner scores over the long-term: a systematic review and meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc 31:436–448. https://doi.org/10.1007/s00167-022-07046-8CrossRefPubMed

Title: Double-bundle anterior cruciate ligament reconstruction resulted in better International Knee Documentation Committee objective grading at fifteen year follow-up compared to single-bundle reconstruction
Authors: Arttu Seppänen
Piia Suomalainen
Tommi Kiekara
Heikki Mäenpää
Heini Huhtala
Timo Järvelä
Publication date: 10-02-2024
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 4/2024
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-024-06106-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Double-bundle anterior cruciate ligament reconstruction resulted in better International Knee Documentation Committee objective grading at fifteen year follow-up compared to single-bundle reconstruction

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2024

Predicting postoperative coronal alignment after fixed-bearing unicompartmental knee arthroplasty using a new morphological assessment method: the arithmetic hip-knee-ankle angle

History of proximal femur fractures in the German literature

A formula for instability-related bone loss: estimating glenoid width and redefining bare spot

Total hip replacement among sickle cell patients in a low-income country–Yemen

Non-metastatic hip fractures surgery in patients with active cancer: benefit and risk

Arthroscopic surgery for ankle gouty arthritis: a retrospective analysis of clinical outcomes at six month follow-up based on a novel classification system