Single-bundle patellar tendon versus non-anatomical double-bundle hamstrings ACL reconstruction: a prospective randomized study at 8-year minimum follow-up

Knee Surg Sports Traumatol Arthrosc. 2011 Mar;19(3):390-7. doi: 10.1007/s00167-010-1225-y. Epub 2010 Jul 29.


Purpose: The purpose of this study was to compare subjective, objective and radiographic outcome of the lateralized single-bundle bone-patellar tendon-bone autograft with a non-anatomical double-bundle hamstring tendons autograft anterior cruciate ligament (ACL) reconstruction technique at long-term follow-up.

Methods: Seventy-nine non-consecutive randomized patients (42 men; 37 women) with unilateral ACL insufficiency were prospectively evaluated, before and after ACL reconstruction by means of the above-mentioned techniques, with a minimum follow-up of 8 years (range 8-10 years; mean 8.6 years). In the double-bundle hamstrings technique, we used one tibial and one femoral tunnel combined with one "over-the-top" passage, cortical staple's fixation and we left intact hamstrings' tibial insertion. Patients were evaluated subjectively and objectively, using IKDC score, Tegner level, manual maximum displacement test with KT-2000™ arthrometer. Radiographic evaluation was performed according to IKDC grading system, and re-intervention rate for meniscal lesions was also recorded.

Results: The subjective and objective IKDC were similar in both groups while double-bundle hamstrings group showed significantly higher Tegner level (P = 0.0007), higher passive range of motion recovery (P = 0.0014), faster sport resumption (P = 0.0052), lower glide pivot-shift phenomenon (P = 0.0302) and lower re-intervention rate (P = 0.0116) compared with patellar tendon group. Radiographic evaluation showed significant lower objective degenerative changes in double-bundle hamstrings group at final follow-up (P = 0.0056).

Conclusion: Although both techniques provide satisfactory results, double-bundle ACL reconstruction shows better functional results, with a faster return to sport activity, a lower re-operation rate and lower degenerative knee changes.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Anterior Cruciate Ligament / surgery*
  • Anterior Cruciate Ligament Injuries*
  • Arthroscopy / methods
  • Chi-Square Distribution
  • Female
  • Follow-Up Studies
  • Humans
  • Joint Instability / prevention & control*
  • Knee Injuries / diagnostic imaging
  • Knee Injuries / surgery
  • Male
  • Pain Measurement
  • Patellar Ligament / transplantation*
  • Plastic Surgery Procedures / adverse effects
  • Plastic Surgery Procedures / methods*
  • Prospective Studies
  • Radiography
  • Range of Motion, Articular / physiology
  • Recovery of Function
  • Reference Values
  • Risk Assessment
  • Statistics, Nonparametric
  • Tendons / transplantation
  • Time Factors
  • Transplantation, Autologous
  • Treatment Outcome
  • Young Adult