Summary
Double-bundle ACL reconstruction resulted in less graft failures, less total knee replacements, and significantly better objective IKDC score than single-bundle ACL reconstruction during the 15-year follow-up.
Abstract
Background
15-year follow-up comparing double-bundle and single-bundle techniques for anterior cruciate ligament (ACL) reconstruction has not been reported before.
Methods
The baseline data was collected at our institute between March 2003 and February 2008. A total of 153 patients were prospectively randomized into 2 groups of anterior cruciate ligament reconstruction with hamstring autografts using aperture interference screw fixation: single-bundle technique (SB group, n = 78) and double-bundle technique (DB group, n=75). The evaluation methods were clinical examination, KT-1000 arthrometric measurement, the International Knee Documentation Committee (IKDC) and the Lysholm knee scores. All the operations were performed by 1 experienced orthopaedic surgeon, and all clinical assessments were made by 1 blinded and independent examiner.
Results
There were no differences between the study groups preoperatively. Sixty percent of patients (n = 92, 53 in the SB group, and 39 in the DB group) were available at a minimum 15-year follow-up. Eighteen patients (13 in the SB group, and 5 in the DB group) had graft failure during the follow-up and had anterior cruciate ligament revision surgery. Five patients (4 in the SB group, and 1 in the DB group) ended up to total knee replacement during the follow-up. In addition, fourteen patients (7 in the SB group, and 7 in the DB group) had an ACL tear of the contraleral knee during the follow-up. Therefore, 55 patients (29 in the SB group, and 26 in the DB group) were accepted for statistical analysis. The objective IKDC score was significantly better in the DB group comparing to SB group (p=0.002). In the subjective knee scores and in the stability measurements no significant difference was found between the groups.
Discussion
Double-bundle ACL reconstruction resulted in less graft failures, less total knee replacements, and significantly better objective IKDC score than single-bundle ACL reconstruction during the 15-year follow-up.