A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques

Arthroscopy. 2007 Jun;23(6):618-28. doi: 10.1016/j.arthro.2007.04.010.


Purpose: A randomized clinical study was conducted to compare the outcome between double-bundle (DB) and single-bundle (SB) anterior cruciate ligament (ACL) reconstructions with 4-strand semitendinosus tendon (ST).

Methods: We divided 68 patients with unilateral ACL injury into 2 groups according to their birth date, and they were followed up in person for a mean of 25 months (range, 18 to 41 months). Each group of 34 patients underwent either DB or SB ACL reconstruction using 4-strand ST with EndoButton femoral fixation (Smith & Nephew Endoscopy, Andover, MA) and anchor staple tibial fixation. There was no difference between the 2 groups with regard to age at surgery, sex, follow-up period, period before surgery, combined meniscus injuries, and athletic activity level. All patients followed the same postoperative program. They were evaluated using manual knee laxity tests, instrumented anterior laxity measurements (KT-1000 arthrometer [MEDmetric, San Diego, CA]), knee extension and flexion strength testing, and so on. General knee condition was evaluated by use of the Lysholm knee score and subjective rating scale.

Results: There were no significant differences between the 2 groups with regard to range of motion, thigh girth, muscle strength, and Lysholm score. Manual knee laxity testing revealed that negative Lachman and pivot-shift test results were found in more patients in the DB group than in the SB group. KT measurements averaged 2.4 mm in the SB group and 1.4 mm in the DB group, which was statistically significantly different. Statistical analysis showed no significant difference regarding all of the modified International Knee Documentation Committee-categorized data between the 2 groups.

Conclusions: This randomized controlled trial indicated that DB ACL reconstruction via 4-strand ST is superior to the SB technique with regard to anterior and rotational stability; however, it fails to show any subjective difference.

Level of evidence: Level I, prospective randomized controlled clinical study.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Anterior Cruciate Ligament / surgery*
  • Anterior Cruciate Ligament Injuries
  • Arthroscopy / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Tendons / transplantation*