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  • Title: Outcome of single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: a meta-analysis.
    Author: Meredick RB, Vance KJ, Appleby D, Lubowitz JH.
    Journal: Am J Sports Med; 2008 Jul; 36(7):1414-21. PubMed ID: 18508977.
    Abstract:
    BACKGROUND: The anterior cruciate ligament (ACL) has 2 anatomic bundles. Standard ACL reconstruction is with a single-bundle graft, but double-bundle reconstruction may better control knee rotational torque, a potential cause of failure after single-bundle reconstruction. The authors investigated outcomes of single-bundle versus double-bundle ACL reconstruction. HYPOTHESIS: There is no difference in outcomes of single-bundle versus double-bundle reconstruction. STUDY DESIGN: Meta-analysis. METHODS: The authors systematically identified randomized controlled trials (RCTs) comparing single-bundle versus double-bundle ACL reconstruction (secondary analysis includes nonrandomized trials). Outcomes reported in a majority of included trials were meta-analyzed. RESULTS: Four RCTs were included (secondary analysis including 5 additional trials yielded reassuringly similar results). Two outcome measures were reported (in a manner permitting meta-analysis) in at least 3 of 4 trials: KT-1000 arthrometer and pivot-shift testing. On average, KT-1000 arthrometer side-to-side difference was 0.52 mm closer to normal in patients treated with double-bundle reconstruction. This difference is demonstrated to be clinically insignificant. In addition, there was no statistical difference in the odds of having a normal or nearly normal pivot-shift result in patients treated with double-bundle versus single-bundle reconstruction. CONCLUSION: Double-bundle reconstruction does not result in clinically significant differences in KT-1000 arthrometer or pivot-shift testing. The pivot-shift results have particular clinical relevance because the test is designed to evaluate knee rotational instability; the results do not support the theory that double-bundle reconstruction better controls knee rotation. Improved quality of future RCTs would allow meta-analysis of a greater number of outcome measures including measures of symptoms and disabilities most important to patients.
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