Double bundle ACL reconstruction provides superior anterior and rotational laxity results .
This report has been verified
by one or more authors of the
original publication.
This study has been identified as potentially high impact.
OE's AI-driven High Impact metric estimates the influence a paper is likely to have by integrating signals from both the journal in which it is published and the scientific content of the article itself.
Developed using state-of-the-art natural language processing, the OE High Impact model more accurately predicts a study's future citation performance than journal impact factor alone.
This enables earlier recognition of clinically meaningful research and helps readers focus on articles most likely to shape future practice.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(12):225 Arthroscopy. 2012 Mar;28(3):405-24From the literature, 12 studies were identified (5 randomized trials and 7 observational studies) that were compiled for meta-analysis of double and single bundle ACL reconstructions. Primary outcomes of concern were anterior and rotational laxity and the range of motion (ROM). Secondary outcomes were IKDC, Lachman test, Lysholm score and Tegner test. The meta-analysis of randomized trials indicated favorable results for double bundle reconstruction in terms of anterior and rotational laxity, while no differences in ROM were present.
Were the search methods used to find evidence (original research) on the primary question or questions stated?
Was the search for evidence reasonably comprehensive?
Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
Were the criteria used for assessing the validity of the included studies reported?
Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
Were the conclusions made by the author or authors supported by the data and or analysis reported in the overview?
How would you rate the scientific quality of this evidence?
Yes = 1
Uncertain = 0.5
Not Relevant = 0
No = 0
The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.
4/4
Introduction
4/4
Accessing Data
4/4
Analysing Data
4/4
Results
3/4
Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.
Why was this study needed now?
A number of different reconstruction methods are used for the repair of ACL deficient knees, and single bundle reconstruction is currently the standard. However, double bundle reconstruction allegedly provides superior anterior and rotational laxity when compared to single bundle, due to a more anatomical restoration of the double bundles of the ACL when placed at the native ACL insertion site. This meta-analysis was conducted to determine if double bundle ACL reconstruction leads to better clinical outcomes. Sub group analysis of studies with greater than two year follow-up and those that used anatomical reconstruction was also completed.
What was the principal research question?
Does double-bundle anterior cruciate ligament reconstruction lead to reduced anterior and rotational laxity and range of motion compared to single bundle repair?
- Double bundle ACL reconstruction provided superior anterior laxity scores measured by KT 1000 arthrometer, with a mean difference of 0.56mm when compared to single bundle reconstruction in the randomized trials (95% CI; -0.98 - -0.14) (p=0.009)
- Pivot shift testing in the randomized trials favored double bundle reconstruction with an RR 0.31 (95% CI; 0.16 - 0.61) (p=0.0007) indicating a 69% reduction in the risk of a positive pivot shift test
- There were no differences in range of motion between single and double bundle reconstructions in the randomized or observational trials
- The observational studies demonstrated a 67% reduction in the risk of a positive Lachman test for double bundle reconstruction (RR 0.33; 95% CI; 0.17 to 0.65 p=0.001)
- Assessment of anatomical reconstructions demonstrated favorable results for KT arthrometer, mean difference -0.70mm, and pivot shift test, RR 0.29, for anatomical double bundle reconstruction compared to single bundle
- Non-anatomical double bundle reconstruction had a relative risk of extension deficit that was 2.7 times greater than non-anatomical single bundle reconstruction
What should I remember most?
The meta-analysis demonstrated that double bundle ACL reconstruction provided superior anterior laxity and rotational laxity as measure by KT arthrometer, Lachman test and pivot shift test. Subgroup analyses of studies with a follow-up greater than two years and anatomical double and single bundle reconstruction also found similar results.
How will this affect the care of my patients?
Further study using long-term follow-up are required to detect and assess degenerative changes due to abnormal kinematics. Until this research provides conclusive results both anatomical single and double bundle reconstruction are adequate options for those with ACL deficient knees.
DISCLAIMER
This content found on this page is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. If you require medical treatment, always seek the advice of your physician or go to your nearest emergency department. The opinions, beliefs, and viewpoints expressed by the individuals on the content found on this page do not reflect the opinions, beliefs, and viewpoints of OrthoEvidence.
0 of 4 monthly FREE articles unlocked
