Clinical outcomes of the anatomical double-bundle anterior cruciate ligament reconstruction compared with the single-bundle technique: A Systematic Review and Meta-analysis.

Objective: This meta-analysis aims to evaluate clinical outcomes of arthroscopic single-bundle (SB) versus anatomical double-bundle (ADB) anterior cruciate ligament (ACL) reconstruction in ACL-injured adults. With the synthesis of all accessible randomized controlled trials (RCTs), it was hypothesized that the ADB method is superior to the SB technique. Methods: The PRISMA checklist’s instructions were followed. To identify RCTs that compared the SB and ADB treatments, a thorough literature search was conducted through electronic resources including PubMed, Embase, Cochrane library, and Web of Science. The methodological quality of each included study was assessed by two independent authors by the Cochrane Collaboration’s risk of bias tool. The ADB techniques of all included studies were screened by the AARSC to determine the eligibility of operation. Nine clinical outcomes were extracted to compare the two techniques. We used the Review Manager 5.3 to make this analysis. Results: This meta-analysis included 20 randomized controlled studies comparing outcomes between ADB with SB techniques in ACL reconstruction. After a minimum follow-up of 12 months, the ADB technique was similar to SB technique in subjective clinical outcomes, including IKDC subjective score, Lysholm score, Tegner activity score. Similar results were also found in the objective outcomes, such as IKDC objective grade, Pivot-shift test, Lachman test, Side-to-side difference, and OA change. Conclusion: In general, when the ACL reconstruction approach meets the minimal total AARSC score of eight, the ADB and SB techniques can result in similar subjective results and knee laxity. Level of evidence I.