Single- versus double-bundle ACL reconstruction: is there any difference in stability and function at 3-year followup?

Clin Orthop Relat Res. 2012 Mar;470(3):824-34. doi: 10.1007/s11999-011-1940-9.


Background: Despite a number of studies comparing postoperative stability and function after anatomic double-bundle and single-bundle anterior cruciate ligament reconstruction (ACLR), it remains unclear whether double-bundle reconstruction improves stability or function.

Questions/purposes: We therefore asked whether patients having single- and double-bundle ACLR using semitendinosus (ST) alone differed with regard to (1) postoperative stability; (2) ROM; and (3) five functional scores.

Methods: We prospectively followed 60 patients with an isolated anterior cruciate ligament (ACL) injury. Thirty patients underwent single-bundle and 30 patients underwent double-bundle ACL reconstruction. Clinically we assessed stability and range of motion (ROM); anteroposterior stability was assessed by Rolimeter and rotational stability by a pivot shift test. Function was assessed by IKDC, Noyes, Lysholm, Marx, and Tegner activity scales. The minimum followup was 36 months (mean, 46.2 months; range, 36-60 months).

Results: Residual anteroposterior laxity at 3 years postoperatively was similar in both groups: 1.4 ± 0.3 mm versus 1.4 ± 0.2 mm, respectively. We observed no difference in the pivot shift test. ROM was similar in both groups, although double-bundle patients required more physical therapy sessions to gain full ROM. IKDC, Noyes, Lysholm, Marx, and Tegner scores were similar at final followup.

Conclusion: Double-bundle reconstruction of the ACL did not improve function or stability compared with single-bundle reconstruction.

Level of evidence: Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Anterior Cruciate Ligament Injuries
  • Anterior Cruciate Ligament Reconstruction / methods*
  • Athletic Injuries / physiopathology
  • Athletic Injuries / rehabilitation
  • Athletic Injuries / surgery
  • Female
  • Humans
  • Knee Injuries / physiopathology
  • Knee Injuries / rehabilitation
  • Knee Injuries / surgery*
  • Knee Joint / physiopathology*
  • Male
  • Prospective Studies
  • Range of Motion, Articular
  • Recovery of Function
  • Rupture
  • Treatment Outcome