Double-bundle versus single-bundle anterior cruciate ligament reconstruction: A prospective randomized study with 5-year results
Suomalainen P, Jarvela T, Paakkala A, Kannus P, & Jarvinen M. The American Journal of Sports Medicine. 2012; doi 10.1177/0363546512448177
There have been quite a few studies and SMR postings regarding anterior cruciate ligament (ACL) reconstruction and whether or not the double-bundle (DB) technique is more beneficial than the single-bundle (SB) technique. However, few studies have focused on the long-term results of these surgical outcomes. The purpose of this randomized controlled trial was to determine whether the DB has better long-term outcomes than the SB for ACL reconstruction. Patients were previously randomized to one of 3 surgical groups: DB, SB with bioabsorbable screw, and SB with metal screw. All grafts were confirmed to be anatomic placement at the 2-year follow-up with MRI. Some patients were lost during the follow up period, which resulted in a total of 65 patients at the 5-year follow up. No differences were found between groups with their clinical (KT-1000, IKDC, Lysholm, or pivot-shift results) or their radiologic findings. While there were no differences between groups in radiologic findings, there was a correlation found between meniscal status and radiologic evidence of osteoarthritis when both groups were pooled together. Lastly, significantly higher re-rupture rates were found in the SB group.
Clinically, the debate continues as to whether or not the DB is superior to the SB ACL reconstruction. Theoretically, we would expect the DB to be superior in clinical and radiologic outcomes; however this has yet to be demonstrated. This is the first study to follow a group of patients long term, and has shown that there are no differences in the development of OA. However, 5 years may not be enough time to see these changes develop. Surgical techniques may not have any influence on the long-term outcomes in the development of OA, as we have seen osteoarthritis incidence rates to be similar in ACL patients regardless if they receive surgery or not. So the injury itself may be the culprit. Additionally, the meniscus seems to play a much larger role in osteoarthritis development, and more attention should be directed towards mitigating these problems. Has the development of surgical interventions been perfected as best as they can be in regards to the short- and long-term results? There are also some theories that suggest osteoarthritis may be triggered by the typical bone bruise or macrotrauma of the injury that occurs during an ACL injury rather than the microtrauma of altered biomechanics post-injury. Perhaps more attention could be directed towards interventions at the time of surgery. Recently, some orthopedic surgeons have started injecting viscosupplements (e.g., hyaluronic acid) immediately post-surgery in efforts to try to prevent the aggressive premature onset of osteoarthritis. Has anyone heard of any physicians trying anything like this or something new?
Written by: Nicole Cattano
Reviewed by: Stephen Thomas
Related Posts:Suomalainen P, Järvelä T, Paakkala A, Kannus P, & Järvinen M (2012). Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective randomized study with 5-year results. The American Journal of Sports Medicine, 40 (7), 1511-8 PMID: 22691456