Double-bundle ACL reconstructions have been proposed as an alternative to the traditional single-bundle procedures in recent years. In theory, better restoration of rotational stability of the knee and lower rates of osteoarthritis years after the surgeries have been suggested to be benefits of double-bundle surgeries.

ACL tear
This arthroscopic image shows the native ACL has complete torn.

A new study presented recently at the American Orthopaedic Society for Sports Medicine’s Specialty Day suggests the double-bundle procedures might not be better than the single-bundle ones – at least in terms of restoring normal knee kinematics.

Mattias Ahldén, MD et al randomized 105 patients to single-bundle or double-bundle ACL reconstructions performed by four surgeons. 98 patients were available at two-year follow up. Among the results studied, they compared outcome scores such as KOOS, Tegner activity level, and Lysholm knee scores. They also compared physical tests such as Lachman’s maneuver, pivot shift test, and KT-1000 arthrometry.

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For all measures, there were no statistically significant differences between the groups of patients who underwent double-bundle and single-bundle ACL reconstructions. Both groups had significant improvements from their assessments after the ACL tears but before surgery.

Patellar tendon ACL graft
This is an arthroscopic image of a patellar tendon graft used for an ACL reconstruction.

This study did not address the long-term development of osteoarthritis. The authors chose to focus on knee stability and return to activity.

“Our study was not intended to show the overall effectiveness of ACL surgery, but instead determine if one surgical approach is better than another in promoting a return to normal activity,” Ahldén explained. “The data shows that in fact multiple surgical approaches can help patients enjoy a return to normalcy after knee injuries.”

These results should not deter orthopedic surgeons who perform double-bundle reconstructions. A large percentage of sports medicine-trained orthopaedic surgeons prefer single-bundle techniques, however. This study provides evidence that good patient outcomes can be obtained with single-bundle reconstruction, especially if anatomic placement of the graft is insured.

Note: The following post appears in a modified form as an article I wrote for Becker’s Orthopedic Review.