Clinical efficacy of anterior cruciate ligament reconstruction: is an anatomical double - bundle or anatomical single - bundle better? A meta-analysis

Purpose: In recent years, anterior cruciate ligament reconstruction (ACLR) technology has developed rapidly and patients report better satisfaction relating to the clinical efficacy. However surgeons remain unsure whether the use of anatomical double-bundle reconstruction is superior to the single bundle. This review aims to compare the clinical outcomes between anatomical double bundle ACL reconstruction (ADB-ACLR) and anatomical single bundle ACL reconstruction (ASB-ACLR) in primary anterior cruciate ligament reconstruction. Methods: A search was performed in the Medline, Embase, and Cochrane databases. Only randomized clinical trials (RCTs) were included in the meta-analysis and all of them were Level I evidence. The comparative outcomes were instrument-measured anterior laxity, Lachman test, pivot shift, clinical outcomes including objective/subjective International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner activity scale and complication rates of graft failure, including early osteoarthritis and extension/flexion deficits. Results: A total of 13 RCT articles and 1887 patients are included. ADB-ACLR led to more rotational stability measured by pivot shift with odds ratio (OR) of 1.70 (95% confidence interval [CI] = 1.18 to 2.45) with heterogeneity (P = 0.01 I-2 = 50%) and revealed statistical significance in a subjective IKDC score with a standard mean difference (SMD) of 0.17 (95% CI = 0.02 to 0.31, P = 0.15 I-2 = 31%) compared with ASB-ACLR. Conclusion: Patients who underwent ADB-ACLR showed better rotational stability, a higher subjective IKDC sore and less flexion deficits compared with ASB-ACLR with no human differences. By using ADB-ACLR, Asian patients had higher Tegner activity scale while American and European patients showed no difference. Other comparative outcomes were not significantly different between ADB-ACLR, ASB-ACLR and human race.