A Meta-Analysis: Clinical Outcome Of Double-bundle Comparing Single-bundle Anterior Cruciate Ligament Reconstruction

BackgroundAnterior cruciate ligament(ACL) injury is common and serious injury in clinical.ACL was consisted by anteromedial(AM) and posterolateral(PL).The PL bundle is tightest in extension,and it becomes relaxed with knee flexion.The AM bundle is tighest in flexion,and it becomes tighted with knee extension.The main function of AM is keeping stability when knee flexed,PL play an important role in keeping rotational stability and anterior stability when knee extensioned.The main symptom of ACL injury is knee instablization,include anterior instability and rotational instability.Arthroscopy ACL reconstruction is the main therapy of ACL injury.Traditional,we only use single-bundle reconstruction(AM),and it can restore anterior stability,but it is insufficient in restoring rotational stability.Mott reported the double-bundle reconstruction in 1983,reconstructing AM and PL simultaneous.Muneta reported the outcome of double-bundle reconstruction in 1999,and found that double-bundle reconstruction can restore better anterior stability compared to single-bundle reconstruction. Since then,there are more and more studies about double-bundle reconstruction and single-bundle reconstruction,but their outcomes are not the same.Now,it is remain to be seen whether the double-bundle reconstruction is better than single-bundle reconstruction and whether performing double-bundle reconstruction in clinical practice is worthwhile.ObjectiveTo evaluate the KT measurements,Pivot shift test and objective IKDC score after double-bundle and single-bundle anterior cruciate ligament reconstruction.In terms of investigating the difference of outcome between double-bundle and single-bundle reconstruction,and provide evidence for the surgery method of ACL reconstruction in clinical.MethodsRandomized controlled trials(RCTs) and Quasi-randomized controlled trials(Quasi-RCTs) were collected from MEDLINE,OVID, The Cochrane Library and CNKI.Evaluate the quality of all studies.Use the Review Manager 4.2 software provided by Cochrane Collaboration to analysis the data.ResultsEight studies met the inclusion criteria,two for B level,six for C level. The KT measurements[WMD=-0.71,CI95%(-1.02,-0.39,P＜0.0001],Pivot shift test[RR=1.34,CI95%(1.19,1.51),P＜0.0001]and objective IKDC scores[RR= 1.34,CI95%(1.19,1.51),P＜0.0001]of double-bundle reconstruction are better than single-bundle,and there is statistical difference between the two groups.ConclusionsThe KT measurements,Pivot shift test,and objective IKDC scores of double-bundle reconstruction are better than single-bundle.ACL double-bundle reconstruction is better than single-bundle in restoring the knee stability and objective sign after surgery,but need supporting by more high quality clinical study.